Major motility disorders
| Disorder | Manometric findingsa | Preferred Treatment |
|---|---|---|
| Achalasia | ||
| Type I (classic) | Non-relaxing LOS + aperistalsis | LHM, PD and POEM |
| Type II (compression) | Non relaxing LOS + oesophageal pressurisation | LHM, PD and POEM |
| Type III (vigorous) | Non-relaxing LOS + increased contractile vigour | |
| OGJ outflow obstruction | ||
| Idiopathic | Non-relaxing LOS + normal peristalsis | Observation, trial of botulinum toxin and PD (if diagnosis definitive) |
| Secondary causes | Incompletely expressed achalasia, EoE, strictures, post-surgery (eg antireflux) or opioids | EoE: oral steroids Strictures: endoscopic dilation Opioids: withdrawal or reduction CCB, botulinum toxin and PD |
| Major motility disorders | ||
| Diffuse spasm | Relaxing LOS + premature contraction | PPI, CCB/nitrates and botulinum toxin |
| Jackhammer oesophagus | Relaxing LOS + increased contractile vigour | PPI, CCB/nitrates and botulinum toxin |
| Absent peristalsis | Relaxing LOS + loss of peristalsis | Conservative management and PPI |
↵a = for a detailed explanation of the parameters involved please refer to Chicago classification version 4;10 CCB = calcium channel blocker; EoE = eosinophilic oesophagitis; LHM = laparoscopic hiller myotomy; LOS = lower oesophageal sphincter; OGJ = oesophago-gastic junction; PD = pneumatic dilation; POEM = per-oral endoscopic myotomy; PPI = proton pump inhibitors.