Title: Endoscopic evaluation of esophageal motility disorders : GI Motility online
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Review
Endoscopic evaluation of esophageal motility disorders
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Key Points
Introduction
Achalasia
Figure 1: a: Barium esophagram showing a dilated, tortuous esophagus and a "bird's beak" appearance of the lower esophageal sphincter ( LES ).
Figure 2: Dilated, fluid-filled esophagus in a patient with achalasia.
Figure 3: Candida esophagitis in a patient with achalasia.
Figure 4: Two examples of a puckered lower esophageal sphincter in patients with achalasia.
Scleroderma
Figure 5: Retroflexed view showing a patulous gastroesophageal junction in a patient with scleroderma.
Spastic Disorders of the Esophagus
Figure 6: A fairly normal-appearing esophagus in a patient with symptomatic nutcracker esophagus.
Esophageal Diverticula
Figure 7: Several epiphrenic diverticula in a patient with reflux esophagitis and a peptic stricture.
Figure 8: Zenker's diverticulum.
Figure 9: Barium x-ray swallowing study showing a large mid-esophageal pulsion diverticulum.
Eosinophilic Esophagitis
Figure 10: Multiple esophageal rings.
Figure 11: Fine circumferential folds, which disappear with continued air insufflation.
Other Ringed Esophagus
Conclusion
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References

Content: Endoscopic findings include a patulous GEJ ( Figure 5 ), esophagitis, and even Barrett's esophagus due to the hypotensive LES, stricture due to reflux, a hypotonic esophagus, or Candida esophagitis due to stasis. Although Ling and Johnston 12 found that endoscopy was not a sensitive means to evaluate the esophagus in connective tissue disease patients, especially when compared with manometry, at videoendoscopy, Cameron et al. 3 noted that the LES remained widely open in 12 of 13 patients with scleroderma. Ten of 13 scleroderma patients showed a typical motility abnormality consisting of a normal contraction in the upper esophagus and no contraction in the middle and distal esophagus. 3
Figure 5: Retroflexed view showing a patulous gastroesophageal junction in a patient with scleroderma. ( Source: Courtesy of Drew Schembre, M.D.)
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Spastic Disorders of the Esophagus
Diffuse esophageal spasm ( DES) or "corkscrew" esophagus and nutcracker esophagus are diagnosed by manometry, with DES showing abnormal simultaneous contractions in the esophageal body and nutcracker esophagus characterized by extremely high-amplitude distal esophageal contractions (mean greater than 180 mmHg). Both cause intermittent dysphagia to liquids and solids, and chest pain, which can radiate to the arms or back. The pain can be precipitated with eating, but can also occur at other times.