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©The Author(s) 2021.
World J Gastroenterol. Apr 28, 2021; 27(16): 1751-1769
Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1751
Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1751
Diagnosis | Definition | Clinical symptoms | Pathophysiology | Diagnostic evaluation |
Structural disorders | ||||
GERD | Symptoms and complications secondary to the reflux of gastic contents above the lower esophageal sphincter[5] | Regurgitation, reflux, dysphagia, retrosternal non-cardiac chest pain, globus sensation, extra esophageal symptoms | Abnormal transient LES relaxation, LES dysfunction secondary to anatomic abnormality such as hiatal hernia | Upper endoscopy, high resolution manometry, ambulatory pH testing, ambulatory impedance testing |
Weak acid reflux | Symptoms secondary to reflux of gastric contents above the LES with pH ranging from 4-7[32] | Reflux, regurgitation, non-cardiac chest pain | Persistent reflux with pH from 4-7 due to transient LES relaxation | pH studies - on maximum PPI therapy |
Eosinophilic esophagitis | Presence of symptoms of esophageal dysfunction such as reflux or dysphagia, eosinophilic inflammation on esophageal biopsy with ≥ 15 eosinophils per high power field, and exclusion of other disorders with similar presentations[81] | Dysphagia, reflux, non-cardiac chest pain | Eosinophil mediated inflammatory response in the esophagus secondary to allergenic antigens | Upper endoscopy with biopsy |
Motility disorders | ||||
Achalasia | Elevated IRP > 15 mmHg and absence of normal peristalsis[44] | Dysphagia, regurgitation, non-cardiac chest pain | Failure of LES relaxation and absence of normal peristalsis | High resolution manometry, upper endoscopy, barium studies |
Absent peristalsis | Systemic symptoms with aperistalsis with failed peristalsis on 100% of swallows[49] | Reflux, dysphagia, non-cardiac chest pain | Lower esophageal collagen deposition leading to LES dysfunction | High resolution manometry, autoimmune antibody workup |
Distal esophageal spasm | Normal IRP and ≥ 20% premature contractions with DCI > 450 mmHg[44] | Dysphagia, regurgitation, reflux, non-cardiac chest pain | Impaired inhibition and coordination of esophageal muscle contraction | High resolution manometry, Barium swallow “corkscrew esophagus” |
Hypercontractile esophagus | Minimum of 2 swallows with DCI > 8000 mmHg[44] | Retrosternal non-cardiac chest pain, dysphagia, regurgitation | Increased contraction of esophageal smooth muscle | Upper endoscopy, barium studies, high resolution manometry |
Esophagogastric junction outflow obstruction | Elevated median IRP > 15 mmHg with evidence of peristalsis on swallows[44] | Dysphagia, reflux, regurgitation | Impairment of esophagogastric junction relaxation with normal or weakened esophageal peristalsis | High resolution manometry, needs to be confirmed with further studies such as barium swallow or endoflip, must rule out artifact that can be seen with a hiatal hernia |
Opioid induced esophageal dysfunction | Presence of symptoms of esophageal dysfunction with manometric evidence of esophageal dysmotility in the presence of chronic opioid use[55] | Regurgitation, dysphagia, reflux | Opioid induced blocking of esophageal inhibitory signals leading to increased spastic contraction and decreased LES relaxation | Clinical history, high resolution manometry |
Gastroparesis | Presence of symptoms such as nausea, vomiting, and early satiety with mechanical obstruction ruled out and evidence of delayed gastric emptying on testing[82] | Nausea, reflux, regurgitation, early satiety, abdominal pain and bloating | Multiple etiologies caused slowed peristalsis and delayed gastric emptying | Gastric emptying study |
Functional disorders | ||||
Functional heartburn | Presence of burning retrosternal discomfort, no symptoms relief on optimal therapy, absence of GERD or EOE as cause of symptoms, and absence of major motility disorder[83] | Reflux, regurgitation, globus sensation | Potentially secondary to increased esophageal sensitivity | Upper endoscopy, high resolution manometry, pH-impedance studies |
Reflux hypersensitivity | Presence of retrosternal chest pain, normal endoscopy and absence of EOE, absence of major motility disorder, and symptom association with reflux events with normal acid exposure on pH-impedance tests[83] | Reflux | Hypersensitization of esophageal nerve endings leading to pain secondary to physiologic esophageal stimuli | Upper endoscopy, high resolution manometry, pH-impedance studies |
Rumination | Must include both persistent regurgitation of recently ingested food with subsequent spitting or re-mastication, and regurgitation that is not preceded by retching[83] | Regurgitation (frequently after meals), reflux | Behavioral contraction of abdominal muscles leading to increased intragastric pressure and reflux | Clinical history, high resolution manometry, pH-impedance studies |
Supragastric belching | Presence of frequent repetitive belching, no established clinical correlate for gastric belching, and evidence of supragastric origin on impedance testing[83] | Frequent belching, reflux, regurgitation, globus sensation | Behavioral swallowing of air without LES relaxation | Clinical history, high resolution manometry, pH-impedance studies |
- Citation: Yodice M, Mignucci A, Shah V, Ashley C, Tadros M. Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing. World J Gastroenterol 2021; 27(16): 1751-1769
- URL: https://www.wjgnet.com/1007-9327/full/v27/i16/1751.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i16.1751