Esophageal Motility Disorders: A Concise Review on Classification, Diagnosis, and Management

Esophageal motility disorders (EMDs) are an underrecognized cause of dysphagia and encompass a breadth of conditions, including achalasia, esophagogastric junction outflow obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus, and ineffective esophageal motility. Whereas patients with EMDs classically present with dysphagia to both solids and liquids, other symptoms such as heartburn, noncardiac chest pain, and regurgitation may also be present. The advent and standardization of high-resolution esophageal manometry by the Chicago Classification have revolutionized the diagnosis and management of EMDs. The EMDs are broadly classified into disorders of the esophagogastric junction (achalasia, esophagogastric junction outflow obstruction) and peristalsis (absent contractility, distal esophageal spasm, hypercontractile esophagus, ineffective esophageal motility). Additional tests, such as timed barium esophagogram and EndoFLIP, can help provide adjunctive information in cases in which high-resolution esophageal manometry findings are inconclusive. Management varies widely according to the type of EMD and can range from lifestyle and dietary modifications to oral pharmacologic therapy and various endoscopic or surgical interventions. In patients with achalasia, durable management aimed at the lower esophageal sphincter should strongly be considered. This clinical review aims to provide a concise yet comprehensive summary on classification, diagnosis, and management of EMDs.