Videoendoscopic diagnosis of esophageal motility disorders

Background: Esophageal motility disorders are usually diagnosed by manometr y. We evaluated videoendoscopy as a diagnostic test. Methods: In this study, 20 patients with achalasia, 13 with scleroderma, an d 33 control subjects had a standard endoscopic examination followed by pro tocol videotaping of swallows to observe contractions in the esophagus and in the lower esophageal sphincter. Tapes were later reviewed by 2 blinded o bservers who recorded their motility findings and diagnoses. Results: In the mid esophagus at 25 cm, lumen-occluding peristaltic contrac tions were identified in 26 of 33 control subjects versus 1 of 20 achalasia (p < 0.001) and 3 of 13 scleroderma patients (p < 0.005). As viewed in the lower esophagus, the lower esophageal sphincter opened normally in 31 of 3 3 control subjects versus 1 of 20 achalasia (p < 0.001). In scleroderma, th e sphincter never closed in 12 of 13 patients (p < 0.001 versus control sub jects). A diagnostic: sequence of sphincter opening followed by contraction in the esophageal body and subsequent sphincter closing was seen in 33 of 33 control subjects, 2 of 20 achalasia, and 1 of 13 scleroderma patients (b oth, p < 0.001). The observers made the correct diagnosis in 96% of cases. Conclusions: Achalasia and esophageal scleroderma can be identified by endo scopic observation of motility. This procedure may represent an adjunctive diagnostic test to manometry.