THE NEW PRACTICAL EDUCATION FOR GASTROENTEROLOGISTS
Esophageal Motility Disorders for the Practicing Gastroenterologist
SPEAKER – Dr. Prakash Gyawali
Key Highlights
Achalasia is characterized by abnormal esophageal peristalsis and a non-relaxing lower esophageal sphincter. Dr. Gyawali details the three subtypes, their unique manometric patterns, and clinical implications, including severe weight loss and esophageal dilation.
Outflow Obstruction Nuances: Esophagogastric junction (EGJ) outflow obstruction is discussed as a “dirty category” — not always abnormal, as it can appear in healthy individuals. The importance of upright swallows and adjunctive testing is emphasized to avoid overdiagnosis.
Diagnostic Pearls: High-resolution manometry, provocative maneuvers, and barium studies are highlighted as essential tools for distinguishing actionable from non-actionable disorders.
Esophageal Motility Disorders for Practicing Clinician
This webinar, led by Dr. Prakash Gyawali, provides a comprehensive and practical guide to diagnosing and managing esophageal motility disorders for practicing gastroenterologists. The session focuses on actionable disorders, diagnostic strategies, and patient-centered management.
Understanding Achalasia and Subtypes
Achalasia is defined by abnormal esophageal peristalsis and a non-relaxing lower esophageal sphincter (LES).
Three Subtypes:
Type I: No peristalsis, non-relaxing LES, severe esophageal dilation, and significant weight loss.
Type II: Retained muscle tone, vertical pressure bands, abnormal LES relaxation, some esophageal pressurization.
Type III: Premature, uncoordinated contractions, some emptying, but persistent symptoms like dysphagia and chest pain.
Esophagogastric Junction (EGJ) Outflow Obstruction
EGJ outflow obstruction is a complex, often ambiguous diagnosis.
Not always abnormal—can be seen in healthy individuals.
Upright swallows and adjunctive tests (barium, manometry) are essential to confirm true obstruction and avoid overdiagnosis.
Diagnostic Approach
High-resolution manometry is the gold standard for identifying motility disorders.
Provocative maneuvers (e.g., rapid drink challenge) and barium studies help distinguish actionable from non-actionable conditions.
Adjunctive testing increases diagnostic confidence and guides management.
Management Strategies
Some motility disorders (e.g., achalasia, true EGJ outflow obstruction) require targeted interventions such as myotomy, pneumatic dilation, or POEM.
Functional or hypersensitivity syndromes are best managed with medical therapy, lifestyle modification, and behavioral interventions.
Patient counseling is critical: explain the nature of the disorder, set realistic expectations, and address anxiety or hypervigilance.
Practical Pearls
Not all motility patterns are clinically significant—avoid overtreatment.
Use a combination of clinical history, manometry, and adjunctive tests for accurate diagnosis.
Individualize therapy based on patient symptoms, test results, and overall health.
In conclusion, Dr. Gyawali’s expert insights equip clinicians to confidently diagnose, explain, and manage esophageal motility disorders. The emphasis on findings, careful use of diagnostics, and patient-centered care ensures optimal outcomes for patients with complex esophageal symptoms.
