Diagnosis and medical management of esophageal dysmotility

Esophageal motility disorders are often suspected in patients with dysphagia and noncardiac chest pain. Even though structural evaluation is important, the primary diagnostic tool is esophageal manometry. With the advent of high-resolution esophageal manometry, the Chicago classification has emerged as the primary scheme to categorize identified manometric abnormalities. However, although some manometric abnormalities associated with achalasia and distal esophageal spasm are well defined, the clinical significance of many identified manometric findings is less clear. Consequently, an understanding of the manometric findings defined by the Chicago classification is important. Furthermore, given the ambiguity associated with many of these findings, medical therapy is often challenging. This review attempts to provide a concise update on interpretation of high-resolution esophageal manometry specifically using the Chicago classification scheme. In addition, we highlight the current evidence for pharmacologic treatment for identified manometric abnormalities.