JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES) ›› 2015, Vol. 53 ›› Issue (6): 58-62.doi: 10.6040/j.issn.1671-7554.0.2014.583

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Analysis of esophageal motility characteristics and causes of non-obstructive dysphagia

DU Quanlin1, CHU Chuanlian2, LI Yanqing3, CHEN Feixue3, TIAN Baoling3   

  1. 1. Department of Gastroenterology, Clinical Institue of Weifang Medical University, Weifang 261053, Shandong, China;
    2. Department of Gastroenterology, Jinan Central Hospital of Shandong University, Jinan 250013, Shandong, China;
    3. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2014-09-06 Revised:2015-03-19 Published:2015-06-10

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Abstract: Objective To analyze the causes and esophageal motility characteristics of patients with non-obstructive dysphagia (NOD) by esophageal high resolution manometry (HRM). Methods Esophageal HRM data of patients with dysphagia treated during Jan. 2011 and May 2014 at Qilu Hospital of Shandong University were collected. Patients suffering from obstructive dysphagia were excluded through history inquiry, endoscopic images and barium examination. Parameters including upper esophageal sphincter pressure (UESP), lower esophageal sphincter pressure (LESP), loweresophageal sphincter length (LESL), residual pressure, integrated relaxation pressure (IRP), distal contractile integral (DCI) and endoscopic results were analyzed. Results Among the 72 patients with NOD, the percentage of achalasia, functional dysphagia and gastroesophageal reflux disease (GERD) was 52.8% (38/72), 33.3% (24/72), 13.9% (10/720), respectively. Of the 38 patients with achalasia, the percentage of absent peristalsis, synchronous contraction, lower esophageal sphincter(LES) incomplete relaxation was 78.9%, 81.6% and 97.4%, respectively. Of the 24 patients with functional dysphagia, the cases of LES incomplete relaxation, upper esophageal sphincter(UES) incomplete relaxation, absent peristalsis, low amplitude peristalsis, distal and esophageal spasm was 16(66.7%), 7(29.2%), 4(16.7%), 8(33.3%) and 2(8.3%). The median (IQR) of LESP, residual pressure, IRP in achalasia patients were 17 (8, 28), 11 (6, 19), 9 (4, 18) respectively, which were higher than those of functional dysphagia group[9(5, 14), 4(0, 7), 2(0, 6), P<0.05]. No difference was found in UESP, LESL and DCI between the two groups. Residual pressure, IRP of patients with achalasia was higher than that of GERD group[11(6, 19) vs 4(3, 7), P=0.005, 9(4, 18) vs 3(1, 5), P=0.007]. There was no difference between functional dysphagia and GERD. Esophageal dilatation, food retention, and cardia stricture were the main endoscopic presentations of achalasia. Functional dysphagia group had no specific endoscopic change. In group of GERD, 3 cases showed erosive esophagitis and 7 cases had no obvious endoscopic abnormalities. Conclusions Achalasia is the most common cause of NOD, followed by functional dysphagia. The pathogenesis of NOD is diverse. Abnormal peristalsis and LES incomplete relaxation are the most two important factors of NOD. HRM is an important method for the diagnosis of NOD.

Key words: Dysphagia, Esophageal achalasia, Esophageal Disorder, Endoscopy, Manometry

CLC Number: 

  • R571
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