Match each esophageal motility disorder with its characteristic high-resolution manometry … — USMLE Step 2 CK

Match each esophageal motility disorder with its characteristic high-resolution manometry (HRM) findings according to the Chicago Classification.

Scleroderma esophagusAbsent contractility in the smooth muscle portion with a hypotensive lower esophageal sphincter
Type I (Classic) Achalasia100% failed peristalsis with impaired lower esophageal sphincter relaxation and no pan-esophageal pressurization
Distal esophageal spasmNormal lower esophageal sphincter relaxation with premature contractions in $\ge 20\%$ of swallows
Hypercontractile (Jackhammer) esophagusCoordinated peristalsis with markedly increased contractile vigor (Distal Contractile Integral $> 8,000 \text{ mmHg} \cdot \text{s} \cdot \text{cm}$ )
Type III (Spastic) AchalasiaImpaired lower esophageal sphincter relaxation accompanied by premature or spastic distal contractions

Answer

Scleroderma esophagus matches with absent contractility and hypotensive LES. Type I Achalasia matches with absent peristalsis, impaired LES relaxation, and no pressurization. Distal esophageal spasm matches with normal LES relaxation and premature contractions. Jackhammer esophagus matches with coordinated peristalsis and extremely high contractile vigor. Type III Achalasia matches with impaired LES relaxation and spastic contractions.

Each matching pair correctly associates the distinct pathophysiology of the esophageal disorder with its formal manometric definition according to the Chicago Classification guidelines for esophageal motility disorders.

Step-by-Step Solution

Analyze lower esophageal sphincter (LES) pressure and relaxation status.

Achalasia variants (Type I, II, III) have impaired relaxation; Scleroderma has a hypotensive LES; Distal esophageal spasm and Jackhammer esophagus have normal LES relaxation.

LES function is the primary diagnostic branch point in the Chicago Classification of esophageal motility disorders.

Evaluate the pattern of distal esophageal peristalsis.

Type I Achalasia lacks pressurization; Type III has spastic contractions; Distal esophageal spasm has premature contractions; Jackhammer has extreme hypercontractility; Scleroderma has completely absent smooth muscle contractility.

Specific peristaltic patterns differentiate the specific subtypes of achalasia from other major and minor functional outflow obstructions.

Key Concept

Diagnosis of Esophageal Motility Disorders via High-Resolution Manometry

Question

Answer

Step-by-Step Solution

Key Concept

Common Mistakes

Topics

More questions from this topic