Improved esophagography screening for esophageal motility disorders using wave appearance and supra-junctional ballooning

A review of recent developments in the imaging of disorders of gut-brain interaction

A number of factors have been recently associated with the development of disorders of gut-brain interaction (DGBI), including genetic predisposition, early-life environment, intestinal microbiota, infection, microinflammation, and increased mucosal permeability. In addition, impaired gastrointestinal motility is important not only as a cause of DGBI but also as a consequent final phenotype. Gastrointestinal motor measurements are the predominant method for the assessment of and therapeutic intervention into motor abnormalities. As such, these measurements should be considered for DGBI patients who do not respond to first-line approaches such as behavioral therapy, dietary modifications, and pharmacotherapy. This comprehensive review focuses on the functional changes in the upper gastrointestinal tract caused by DGBI and describes ongoing attempts to develop imaging modalities to assess these dysfunctions in the esophageal and gastric regions. Recent advances in imaging techniques could help elucidate the pathophysiology of DGBI, with exciting potential for research and clinical practice.

Esophageal Motility Disorders: Diagnosis and Treatment Strategies

BACKGROUND

Esophageal motility disorders (EMDs) are caused by the impaired relaxation of the upper/lower esophageal sphincter and/or defective esophageal peristaltic contractions, resulting in dysphagia and noncardiac chest pain. High-resolution manometry (HRM) is essential for the diagnosis of primary EMD; however, the recognition of EMD and HRM by general practitioners in Japan is limited. This review summarizes the diagnosis of and treatment strategies for EMD.

SUMMARY

HRM is a specific test for the diagnosis of EMD, whereas endoscopy and barium swallow as screening tests provide characteristic findings (i.e., esophageal rosette and bird's beak sign) in some cases. It is important to note that manometric diagnoses apart from achalasia are often clinically irrelevant; therefore, the recently updated guidelines suggest additional manometric maneuvers, such as the rapid drink challenge, and further testing, including functional lumen imaging, for a more accurate diagnosis before invasive treatment. Endoscopic/surgical myotomy, pneumatic dilation, and botulinum toxin injections need to be considered for patients with achalasia and clinically relevant esophagogastric junction outflow obstruction.

KEY MESSAGE

Since the detailed pathophysiology of EMD remains unclear, their diagnosis needs to be cautiously established prior to the initiation of invasive treatment.