PD03.03. Clinical Characteristics and Selected Treatment in Patients With Transient Esophageal Motility Abnormalities Detected During Esophagogastroduodenoscopy

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ID: 325641
2026
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Ranked #12 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Esophageal Function and Motility Background Major esophageal motility disorders such as achalasia often present with characteristic abnormalities on esophagogastroduodenoscopy (EGD). However, transient abnormal esophageal contractions or mucosal color changes are occasionally observed during EGD and their meaning are not well understood, and the pathological significance of these findings remains unclear. This study aimed to elucidate symptom profiles, barium esophagography findings, high-resolution manometry (HRM) results, and subsequent treatment performed in patients who exhibited such transient abnormalities during EGD. Methods We conducted a single-center retrospective cohort study of 487 patients who underwent both EGD and HRM between June 2014 and May 2024. Endoscopic reports were reviewed to identify transient esophageal contraction abnormalities and their features. Esophageal motility disorders were diagnosed using the Chicago Classification v3.0, supplemented as needed by symptom-provocation maneuvers and liquid/solid barium esophagography. Results Transient contraction abnormalities during EGD were identified in 20 (4.1%). All 20 patients reported chest pain or dysphagia. The abnormal contraction patterns included corkscrew contractions (n = 4), contractions with mucosal whitening (n = 10), concentric contractions (n = 3), and retrograde or irregular contractions (n = 3). HRM revealed abnormalities in 10 patients(50%): achalasia (type II, n = 3; type III, n = 1), EGJ outflow obstruction (n = 1), jackhammer esophagus (n = 3), and distal esophageal spasm (n = 2). The remaining 10 patients met normal HRM criteria; however, 8 of these demonstrated abnormalities during provocation testing or barium studies. Treatment included peroral endoscopic myotomy (POEM) in 2 patients (jackhammer esophagus, n = 1; type II achalasia, n = 1), pneumatic balloon dilation in 2 patients (type II achalasia), pharmacologic therapy such as anticholinergics or nitrates in 6 patients, and observation without intervention in 10 patients. Conclusion Although transient contraction abnormalities observed during EGD were often associated with symptoms, half of these patients showed normal findings on standard HRM, yielding a low diagnostic rate using the Chicago Classification alone. More detailed evaluations, including provocative testing and barium esophagography, frequently revealed underlying abnormalities. Nevertheless, many patients were managed conservatively with medication or observation, with relatively few requiring invasive intervention.
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Authors Hiroko Hosaka, Shiko Kuribayashi, Nozomi Furuichi, Y Maruyama, Keiichi Oshima, Yuki Itoi, Keigo Sato, Hirohito Tanaka, Yoji Takeuchi, Toshio Uraoka
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.089
URL
https://doi.org/10.1093/dote/doag077.089
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