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: 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. 12, 13, 14 Diffuse esophageal spasm can sometimes be seen at the time of endoscopy as a "corkscrew" appearance in the distal esophagus. 14 Nutcracker esophagus often appears normal at endoscopy ( Figure 6 ). A careful look for signs of reflux such as erosions, ulcerations, or strictures is required as gastroesophageal reflux disease may be an underlying cause of these two spastic abnormalities. 15
Figure 6: A fairly normal-appearing esophagus in a patient with symptomatic nutcracker esophagus.