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Gastroenterology68 papers

Nonspecific esophageal motility disorder

Last edited: 4/14/2026

Overview

Nonspecific esophageal motility disorder encompasses a range of motility abnormalities not fitting classic diagnoses like achalasia, characterized by variable patterns of esophageal peristalsis and sphincter function 7.

Diagnosis

  • Key Diagnostic Criteria: Utilize high-resolution manometry (HRM) for detailed assessment of esophageal pressure topography 78.
  • Recommended Tests: Esophageal pressure topography (EPT) offers enhanced characterization over conventional line tracings 8.
  • Grading: Assess using the Chicago Classification system, particularly focusing on Integrated Relaxation Pressure (IRP) and patterns of contractility 11.

    • Management

  • First-Line Treatments: Limited specific treatments mentioned; management often tailored to symptoms and underlying dysfunction 7.
  • Adjunctive Treatments: Consider endoscopic interventions like peroral endoscopic myotomy (POEM) for refractory cases 1.
  • Pharmacological Interventions: No specific drug classes or doses highlighted for nonspecific motility disorders 7.

    • Special Populations

  • Pediatrics: No specific data provided in the abstracts.
  • Elderly: No specific considerations noted in the provided abstracts.
  • Comorbidities: Acute opioid administration does not significantly impact motility classification in these patients, suggesting caution but no contraindication 5.

    • Key Recommendations

  • Employ high-resolution manometry (HRM) for accurate diagnosis of nonspecific esophageal motility disorders (Evidence: Strong 78).
  • Consider endoscopic techniques such as POEM for patients with refractory symptoms (Evidence: Moderate 1).
  • Tailor management strategies based on individual patient symptoms and manometric findings due to limited specific pharmacological interventions (Evidence: Expert opinion).

    • References

    1 Thompson CC, Khashab MA, Stavropoulos SN, Al-Haddad MA, Bang JY, Bazarbashi AN et al.. American Society for Gastrointestinal Endoscopy standards for fellowship training in peroral endoscopic myotomy. Gastrointestinal endoscopy 2026. link 2 Abdel Jalil AA, Koo TH, Marshall JB, Fass R. Gastroenterology Fellow Knowledge of Esophageal Motility and Manometry: Assessment and Improvement Initiative at an Academic Center. Digestive diseases and sciences 2025. link 3 Pezzino EC, Pandolfino JE, Toaz E, Kahrilas PJ, Carlson DA. Endoscopic Sedation Type During FLIP Panometry Does Not Significantly Impact FLIP Motility Classification Relative to Manometry. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2025. link 4 Wang CW, Lees CR, Ko MS, Sewell JL, Kathpalia P. Implementation and Analysis of a 5-Year Online Esophageal Motility Curriculum for Gastroenterology Fellows. Digestive diseases and sciences 2024. link 5 Balko RA, Katzka DA, Murray JA, Alexander JA, Mara KC, Ravi K. Same-day opioid administration in opiate naïve patients is not associated with opioid-induced esophageal dysfunction (OIED). Neurogastroenterology and motility 2021. link 6 Richter JE. Computerized Learning Is a Building Block But We Still Have Far to Go. The American journal of gastroenterology 2020. link 7 Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE. Advances in Management of Esophageal Motility Disorders. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2018. link 8 Carlson DA, Ravi K, Kahrilas PJ, Gyawali CP, Bredenoord AJ, Castell DO et al.. Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography vs. Conventional Line Tracing. The American journal of gastroenterology 2015. link 9 Wexler SJ, Wernick B, Soliman AM. Use of flexible esophagoscopy by otolaryngologists. The Annals of otology, rhinology, and laryngology 2014. link 10 Kempf J, Heinrich H, Reusch CE, Kook PH. Evaluation of esophageal high-resolution manometry in awake and sedated dogs. American journal of veterinary research 2013. link 11 Lin Z, Kahrilas PJ, Roman S, Boris L, Carlson D, Pandolfino JE. Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model. Neurogastroenterology and motility 2012. link 12 Brun R, Staller K, Viner S, Kuo B. Endoscopically assisted water perfusion esophageal manometry with minimal sedation: technique, indications, and implication on the clinical management. Journal of clinical gastroenterology 2011. link 13 Anari S. Endoscopic rigid oesophagoscopy: a simple method to teach rigid oesophagoscopy. The Journal of laryngology and otology 2010. link 14 Tireli GA, Sander S, Demirali O. A simple antireflux barrier for cologastric anastomosis in colonic interposition. Acta chirurgica Belgica 2005. link 15 Swann LA, Munter DW. Esophageal emergencies. Emergency medicine clinics of North America 1996. link70267-4) 16 Voskuil JH, Cramer MJ, Breumelhof R, Timmer R, Smout AJ. Prevalence of esophageal disorders in patients with chest pain newly referred to the cardiologist. Chest 1996. link 17 Wang GQ, Dawsey SM, Zhou MH, Lewin KJ. Gastric heterotopia in the upper esophagus (inlet patch) in endoscopic surveys in northern China. Journal of clinical gastroenterology 1994. link 18 Szántó I, Kiss J. Oesophagus bezoar diagnosed and removed endoscopically. Endoscopy 1976. link

    Original source

    1. [1]
      American Society for Gastrointestinal Endoscopy standards for fellowship training in peroral endoscopic myotomy. — Thompson CC, Khashab MA, Stavropoulos SN, Al-Haddad MA, Bang JY, Bazarbashi AN et al. Gastrointestinal endoscopy (2026)
    2. [2]
      Gastroenterology Fellow Knowledge of Esophageal Motility and Manometry: Assessment and Improvement Initiative at an Academic Center. — Abdel Jalil AA, Koo TH, Marshall JB, Fass R Digestive diseases and sciences (2025)
    3. [3]
      Endoscopic Sedation Type During FLIP Panometry Does Not Significantly Impact FLIP Motility Classification Relative to Manometry. — Pezzino EC, Pandolfino JE, Toaz E, Kahrilas PJ, Carlson DA Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2025)
    4. [4]
      Implementation and Analysis of a 5-Year Online Esophageal Motility Curriculum for Gastroenterology Fellows. — Wang CW, Lees CR, Ko MS, Sewell JL, Kathpalia P Digestive diseases and sciences (2024)
    5. [5]
      Same-day opioid administration in opiate naïve patients is not associated with opioid-induced esophageal dysfunction (OIED). — Balko RA, Katzka DA, Murray JA, Alexander JA, Mara KC, Ravi K Neurogastroenterology and motility (2021)
    6. [6]
      Computerized Learning Is a Building Block But We Still Have Far to Go. — Richter JE The American journal of gastroenterology (2020)
    7. [7]
      Advances in Management of Esophageal Motility Disorders. — Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2018)
    8. [8]
      Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography vs. Conventional Line Tracing. — Carlson DA, Ravi K, Kahrilas PJ, Gyawali CP, Bredenoord AJ, Castell DO et al. The American journal of gastroenterology (2015)
    9. [9]
      Use of flexible esophagoscopy by otolaryngologists. — Wexler SJ, Wernick B, Soliman AM The Annals of otology, rhinology, and laryngology (2014)
    10. [10]
      Evaluation of esophageal high-resolution manometry in awake and sedated dogs. — Kempf J, Heinrich H, Reusch CE, Kook PH American journal of veterinary research (2013)
    11. [11]
      Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model. — Lin Z, Kahrilas PJ, Roman S, Boris L, Carlson D, Pandolfino JE Neurogastroenterology and motility (2012)
    12. [12]
      Endoscopically assisted water perfusion esophageal manometry with minimal sedation: technique, indications, and implication on the clinical management. — Brun R, Staller K, Viner S, Kuo B Journal of clinical gastroenterology (2011)
    13. [13]
      Endoscopic rigid oesophagoscopy: a simple method to teach rigid oesophagoscopy. — Anari S The Journal of laryngology and otology (2010)
    14. [14]
      A simple antireflux barrier for cologastric anastomosis in colonic interposition. — Tireli GA, Sander S, Demirali O Acta chirurgica Belgica (2005)
    15. [15]
      Esophageal emergencies. — Swann LA, Munter DW Emergency medicine clinics of North America (1996)
    16. [16]
      Prevalence of esophageal disorders in patients with chest pain newly referred to the cardiologist. — Voskuil JH, Cramer MJ, Breumelhof R, Timmer R, Smout AJ Chest (1996)
    17. [17]
      Gastric heterotopia in the upper esophagus (inlet patch) in endoscopic surveys in northern China. — Wang GQ, Dawsey SM, Zhou MH, Lewin KJ Journal of clinical gastroenterology (1994)
    18. [18]
      Oesophagus bezoar diagnosed and removed endoscopically. — Szántó I, Kiss J Endoscopy (1976)
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