Clinical Use of Ambulatory 24-H Esophageal Motility Monitoring in the Evaluation of Patients with Primary Esophageal Motor Disorders

Abstract

Motor abnormalities of the esophageal body are frequently implicated as the cause of dysphagia, regurgitation, or non-cardiac chest pain [1–4]. The diagnosis and classification of esophageal motor abnormalities and the proof of a causal relation between the abnormality and a symptom has, however, been difficult in the past for the following reasons: First, there usually is no reliable mucosal lesion that can be observed on endoscopy to indicate the presence of an esophageal motor disorder; second, roentgenographic signs of esophageal motor disorders occur only in advanced disease; third, the current “gold-standard” for the diagnosis of esophageal motor disorders, i.e., stationary esophageal manometry, has several shortcomings—it is performed in a laboratory environment with the patient in a supine position, the analysis is based on the motor response to ten wet or dry swallows only, and intermittent motor abnormalities may be missed; fourth, the current classification of motor disorders is controversial, and does not allow for the quantitation of the severity of the abnormality; fifth, spontaneous symptoms rarely occur during a short-term stationary motility study; and sixth, the use of provocative tests, i.e., acid perfusion, administration of tensilon, or balloon distention, to reproduce the patient’s symptoms is not helpful since most of these tests have a low yield, symptoms are reproduced with unphysiologic stimuli, the endpoint is based on the patients symptom perception, and the results do not correlate with motility abnormalities associated with spontaneously occurring symptoms [4–6].