Esophageal Motility

• Audio chapter
  Attending-narrated, listen on the commute.
• ABIM-format MCQs
  5-option vignettes with full wrong-answer teaching.
• Study guide
  Tables, decision trees, primary sources.
• AI tutor
  Chapter-grounded, answers the question you're stuck on.

What this chapter covers

• Section 2.1: Manometry fundamentals and Chicago v4.0 framework

  High-resolution manometry is the test that converts a swallow into numbers, and the Chicago Classification version 4.0 is the algorithm that converts those numbers into a diagnosis.

• Section 2.2: Achalasia subtypes and management

  Achalasia is the prototypical disorder of EGJ outflow obstruction with absent peristalsis, and the mechanism explains everything that follows on the manometry tracing, on the barium esophagram, and at the time of treatment selection.

• Section 2.3: Distal esophageal spasm and hypercontractile disorders

  Distal esophageal spasm and hypercontractile (jackhammer) esophagus are the disorders of preserved sphincter relaxation but disordered body contraction, and they sit together in the algorithm because both occur on a normal IRP and both produce a chest pain and dysphagia phenotype that often arrives in the GI clinic after a negative cardiac workup.

• Section 2.4: Hypotensive LES, scleroderma, and absent contractility

  Ineffective esophageal motility, absent contractility, and scleroderma esophagus sit together because all three are disorders of failed peristalsis on a normal or low IRP, and they share a downstream consequence of impaired esophageal acid clearance.

• Section 2.5: EGJ outflow obstruction and adjunctive testing with FLIP

  EGJ outflow obstruction (EGJOO) is the heterogeneous bucket that contains every patient with an elevated IRP and some preserved peristalsis, and the v4.0 changes to the diagnostic criteria reflect the recognition that the bucket contains many false positives and that a manometric abnormality alone is not enough to call a disease.

Podcast episodes

1. 01

   Manometry Principles

   This episode covers manometry from first principles, and the whole thing rests on one simple idea: on every swallow the esophagus has two jobs, and the test exists to check whether each one happened.

2. 02

   Achalasia

   This episode covers achalasia, which is where those numbers point most often, and we'll build it from the mechanism, because every strange thing about the disease falls out of one lesion.

3. 03

   Spasm and Hypercontractile

   This episode covers the too-much side: distal esophageal spasm and the hypercontractile esophagus. Distal esophageal spasm and hypercontractile esophagus get taught together for a reason worth internalizing: they present identically, dysphagia and non-cardiac chest pain in someone whose heart is already cleared, and they share a normal IRP, which is the...

4. 04

   Weak Pump Scleroderma Obstruction

   This episode covers the other way a body fails on a normal IRP, doing too little: ineffective motility, absent contractility, and scleroderma. And it closes on the one motility diagnosis you're required to distrust, outflow obstruction, where the IRP is elevated but peristalsis is still firing.