Distal oesophageal peristalitic wave amplitude < 30 mmHg
Semultaneous contractions with amplitude < 30 mmHg
Failed peristalsis in which the peristaltic waves does not traverse the entire length of the distal oesophagus.
Perstalitic waves with mean amplitudes > 2 SD above normal.
Manometric features:
1- Mean distal oesophageal peristalitc wave of amplitude > 18 mmHg.
2- Long duration of peristaltic contracture
3- Resting LOS is usually normal but may be elevated.
Uncoordinated spastic activity in the smooth muscle portion of the oesophagus.
Reptitive and prolong contraction > 6 sec , high amplitude > 180 mmHg.
Manometric features:
1- Spontaneous contracture
2- Repetitive contracture
3- Multiple peaked contractions
4- Intermittent normal perstalesis.
4-classic achalasia:
Aperstalesis of the oesophagus
Failure of relaxation of the LOS on iniatation of the swallowing.
Degenerative lesion of the vagus
Decrease gangilionic cells in the myentric nerve pluses of the oesophageal wall.
The degenerative process involve preferentially the NO, which produce inhibitory neurones that relaxes the sooth muscles of the oesophagus.
Swallow is followed by either no discernible activity in the oesophageal body or by simultaneous oesophageal contraction of low amplitude < 40 mmHg.
Manomertric features:
1- absence of complete LOS relaxation
2- Simultaneous contraction within the oesophageal body
3- Low amplitude of oesophageal contraction
4- Increase tone in LOS
5- Resting intra oesophageal press > intra gastric press
Secondary causes of oesophageal dysmotility:
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