Esophageal motility disorders: a gastroenterologists' perspective for radiologists

Esophageal motility disorders are commonly encountered in the outpatient setting during the evaluation of difficulty swallowing. They typically present with symptoms of dysphagia to solids or liquids, non-cardiac chest pain, or regurgitation. Practitioners rely on both invasive and non-invasive testing to evaluate these complaints, often utilizing endoscopy, fluoroscopic evaluations, and functional esophageal motility testing to characterize symptoms into formal motility disorders, when able. Many of these tests complement each other and more than one is often needed to fully characterize a patient's symptoms. For the past fifteen years, gastroenterologists have primarily used the Chicago Classification for defining esophageal motility disorders by esophageal manometry and this classification scheme has evolved into its 4th iteration. The following paper will review the initial approach to patients presenting with obstructive esophageal symptoms and provide a working knowledge of the Chicago Classification system and additional motility testing used commonly by gastroenterologists.