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Zorluk: ZorGastroenterology and Hepatology

Match the following high-resolution esophageal manometry (HRM) profiles based on the Chicago Classification to their most appropriate clinical diagnoses.

  • Elevated integrated relaxation pressure (IRP>15IRP > 15 mm Hg) and 100%100\% failed peristalsis.Achalasia (Type I)
  • Normal IRPIRP and ≥20%\ge 20\% premature swallows (distal latency <4.5< 4.5 seconds).Distal esophageal spasm
  • Normal IRPIRP and ≥20%\ge 20\% hypercontractile swallows (distal contractile integral >8,000> 8,000 mm Hg ⋅\cdot s ⋅\cdot cm).Jackhammer esophagus
  • Decreased resting lower esophageal sphincter (LES) pressure and absent peristalsis in the smooth muscle portion of the esophagus.Systemic sclerosis (Scleroderma)

Cevap

The correct matches are: Elevated IRP with failed peristalsis corresponds to Achalasia; normal IRP with premature swallows corresponds to Distal esophageal spasm; normal IRP with hypercontractile swallows corresponds to Jackhammer esophagus; and decreased LES pressure with absent peristalsis corresponds to Systemic sclerosis.
The diagnosis of esophageal motility disorders relies on high-resolution manometry (HRM). Achalasia is defined by absent peristalsis and impaired LES relaxation (elevated IRPIRP). Distal esophageal spasm features normal LES relaxation but premature, rapid contractions. Jackhammer esophagus features normal relaxation but extremely high-amplitude, hypercontractile swallows. Systemic sclerosis causes smooth muscle atrophy in the lower two-thirds of the esophagus, resulting in absent peristalsis and a hypotensive LES, which differentiates it from achalasia.

Adım Adım Çözüm

1
Assess the integrated relaxation pressure (IRPIRP) to evaluate lower esophageal sphincter (LES) function.
An elevated IRPIRP (>15> 15 mm Hg) indicates an outflow obstruction, typically pointing to achalasia.
Failure of the LES to relax is the hallmark of achalasia.
2
Evaluate the integrity and timing of peristalsis if the IRPIRP is normal.
Premature swallows indicate distal esophageal spasm, while absent peristalsis with a hypotensive LES suggests scleroderma.
Differentiation of motility disorders relies on contraction pattern (premature vs. absent) when outflow obstruction is ruled out.
3
Assess the vigor of contractions using the distal contractile integral (DCI).
A DCI >8,000> 8,000 mm Hg ⋅\cdot s ⋅\cdot cm indicates Jackhammer esophagus.
Extreme hypercontractility defines this specific motility disorder.

Anahtar Kavram

Diagnosis of esophageal motility disorders using Chicago Classification criteria on high-resolution manometry.
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Konular

Gastroenterology and Hepatology

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