Contraction abnormalities of the esophageal body in patients referred to manometry. A new approach to manometric classification.

A method is proposed for classifying conventional esophageal manometry findings according to the features observed in the esophageal body rather than the disease name. Patients who demonstrate increases in mean distal wave amplitude, mean distal wave duration, or number of abnormal motor responses (repetitive or simultaneous contractions) or the presence of triple-peaked waves are classified as having distal contraction abnormalities. Severity is scored by the cumulative number of these abnormalities. Of the 210 patients referred for esophageal manometry over a 23-month period, 119 (57%) were found to have one or more of the contraction abnormalities, making this the most common esophageal body manometric classification. The presence of one or two abnormalities was most common. Patients with all four abnormalities represented less than 5% of the referred population and, as a group, would satisfy usual manometric criteria for diffuse esophageal spasm. The proposed system allows for recognition of patients with only one or several of the manometric features typically seen in diffuse esophageal spasm and provides a method for intra- and interstudy comparison of patients with these common findings.