The HRM Classification of distal esophageal motility disorders
|
With |
||
|
Disorder |
Criteria |
|
|
Hypotensive peristalsis |
||
|
Intermittent |
More than 50% of swallows with peristaltic defects ≥ 3cm defect in 30mmHg pressure isocontour |
|
|
Frequent |
≥ 70% of swallows with peristaltic defects ≥ 3cm defect in 30mmHg pressure isocontour |
|
|
Aperistalsis |
100% swallows with absent peristalsis |
|
|
Hypertensive peristalsis |
||
|
Nutcracker Esophagus |
Normal CFVfast* (CFV <10 cm/sec), Mean contractile pressure >180mmHg and <260mmHg, LES after-contraction >180mmHg (DCI 5000 - 8000 mmHg/s/cm) |
|
|
Spastic Nutcracker |
Normal CFVfast, Mean contractile pressure >260mmHg (DCI > 8000 mmHg/s/cm) |
|
|
Esophageal Spasm |
Normal EGJ relaxation and simultaneous contraction / spasm (CFV > 10 cm/sec) in ≥30% of swallows |
|
|
Focal |
Spasm limited to mid- or distal-segment of smooth muscle esophagus |
|
|
Diffuse |
Spasm in mid-distal smooth muscle esophagus |
|
|
With Impaired EGJ Relaxation# |
||
|
Disorder |
Criteria |
|
|
Achalasia |
||
|
Classic achalasia |
Impaired EGJ relaxation and aperistalsis |
|
|
Achalasia with esophageal compression |
with panesophageal pressurization in ≥30% swallows |
|
|
Spastic achalasia |
with spasm (CFVfast > 10 cm/sec) in ≥30% swallows |
|
|
Functional EGJ Obstruction * |
IBP >15 mmHg compartmentalized between the peristaltic wavefront (normal or nutcracker) and EGJ |
|
# EGJ relaxation pressures can be calculated using the continuous 3 second nadir using the eSleeve or the 4 second integrated relaxation pressure (IRP). Upper limit of normal for both is 15 mmHg
* CFV is often composed of a fast section in the upper smooth muscle esophagus and a slow section in the lower esophagus separated by a clear "deceleration point". The structural correlate of the fast section is the peristaltic smooth muscle contraction and this should be used for classification. The slow section occurs during emptying of the phrenic ampulla and appears to correlate with return of the esophagus into resting position.
* may represent an achalasia variant
EGJ, esophagogastric junction; IRP, integrated relaxation pressure; IBP, intrabolus pressure; CFV, contractile front velocity; DCI, distal contractile integral.
Source: Pandolfino, Fox, Bredenoord, Kahrilas Neurogastro Motil 2009, modified following HRM consensus group meeting 29th August 2009
| < Prev |
|---|
