Is it necessary to perform a morphological assessment for an esophageal motility disorder? A retrospective descriptive study

Background: Esophageal motility disorders are most often of primary origin but may be secondary to an occult malignancy or another etiology. High-resolution esophageal manometry cannot differentiate between secondary or primary origin. This study aimed at discussing the usefulness of a morphological assessment in the diagnosis of specific esophageal motility disorders, and to establish the predictive factors of a potential secondary origin. Methods: In this retrospective study, patients with suspected esophageal motility disorders who underwent an esophageal manometry were included. High-resolution manometry results were interpreted according to the Chicago Classification, 3rd version. The results of endoscopic ultrasound and computed tomography, assessed by a panel of experts, allowed to diagnose a secondary origin. Key Results: Out of 2138 patients undergoing manometry, 502 patients had a esophageal motility disorder suspect to be from secondary origin; among them 182 patients underwent tomography or endoscopic ultrasound. According to experts, 16 patients (8.8%) had a secondary esophageal motility disorder: esophagogastric junction outflow obstruction (n = 7), jackhammer disorder (n = 4), achalasia (n = 3) and localized pressurization (n = 2). The etiology was malignant in 8 patients. Predictive factors suggesting potential secondary esophageal motility disorders were smoking, age >= 58 years and an Integrated Relaxation Pressure higher than 10 mmHg for water swallows. Conclusion and Inferences: Esophageal motility disorders with organic origin are not uncommon. A morphological assessment using endoscopic ultrasonography and/or computed tomography may be of use to diagnose a secondary origin, especially in the elderly and smokers. (C) 2021 Published by Elsevier Masson SAS.

Automated summary

Esophageal motility disorders of secondary origin are not uncommon, with predictive factors including smoking, age ≥58 years, and an Integrated Relaxation Pressure higher than 10 mmHg. Morphological assessment using endoscopic ultrasonography and/or computed tomography may be useful for diagnosing a secondary origin, especially in the elderly and smokers.