Gastroenterology and hepatology
Oesophageal motility disorders
Dysphagia to solids and liquids, gastroscopy first to exclude cancer, high-resolution manometry and the Chicago Classification 4.0, achalasia subtypes and the choice between dilatation, Heller myotomy and POEM, spastic disorders, and scleroderma oesophagus.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Motility disorders cause dysphagia to solids and liquids from the start, regurgitation of undigested food and non-cardiac chest pain. Mechanical obstruction typically starts with solids.
- Gastroscopy comes first to exclude cancer, strictures and eosinophilic oesophagitis. High-resolution manometry (HRM) then makes the diagnosis, classified by Chicago 4.0.
- Achalasia is the one to know: failed relaxation of the lower oesophageal sphincter and absent peristalsis. It is treated mechanically.
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Sources
- Yadlapati R et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0. Neurogastroenterol Motil 2021;33:e14058International High Resolution Manometry Working Group (Neurogastroenterology and Motility), 4.0 (2021)
- Vaezi MF et al. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol 2020;115:1393-411American College of Gastroenterology, 2020
- Calabrese EC et al. 2024 update to SAGES guidelines for the use of peroral endoscopic myotomy (POEM) in the treatment of achalasia. Surg Endosc 2025Society of American Gastrointestinal and Endoscopic Surgeons, 2024
- Carlson DA et al. A standardized approach to performing and interpreting functional lumen imaging probe panometry for esophageal motility disorders: the Dallas Consensus. Gastroenterology 2025Gastroenterology, 2025
- Werner YB et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 2019;381:2219-29New England Journal of Medicine, 2019
- Last updated
- 14 November 2026
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