Esophageal motility abnormalities in gastroesophageal reflux disease

Table 1 Manometric criteria for esophageal motility associated with gastroesophageal reflux disease

TLESRs: periods (lasting more than 10-60 s) of spontaneous LES relaxation characterized by:

(i) absence of swallowing for 4 s before to 2 s after the onset of LES relaxation,

(ii) relaxation rate of ≥ 1 mmHg/s

(iii) time from onset to complete relaxation of ≤ 10 s

(iv) nadir pressure of ≤ 2 mmHg

LES relaxations associated with a swallow and fulfilling the above mentioned criteria (ii), (iii) and (iv) that lasted more than 10 s are considered as TLESR

Esophagogastric junction:

Type 1: no separation between the LES and the crural diaphragm

Type 2: minimal separation (> 1 and < 2 cm) making for a double-peaked pressure profile that is not yet indicative of hiatal hernia

Type 3: more than 2 cm separation between the LES and the crural diaphragm at inspiration so that two high-pressure zones can be clearly identified

3a: respiratory inversion point distal to the LES

3b: respiratory inversion point proximal to the LES

Weak peristalsis with large (a) and small peristaltic defects (b):

(i) Mean integrated relaxation pressure < 15 mmHg and > 20% swallows with large breaks in the 20 mmHg isobaric contour ( > 5 cm in length)

(ii) Mean integrated relaxation pressure < 15 mmHg and > 30% swallows with small breaks in the 20 mmHg isobaric contour (2–5 cm in length)

LES: Lower esophageal sphincter; TLESRs: Transient lower esophageal sphincter relaxations.