high resolution manometry is investigation of choice in all except

Classification of esophageal motility disorders * Inadequate LES relaxation Classic achalasia Atypical disorders of LES relaxation * Uncoordinated contraction Diffuse esophageal spasm * Hypercontraction Nutcracker esophagus Isolated hypeensive LES * Hypocontraction Ineffective esophageal motility Achalasia Manometric features required for diagnosis * Incomplete relaxation of LES Defined as mean swallow induced fall in resting LES pressure to a nadir value > 8 mm above gastric pressure * Aperistalsis in the body of esophagus Simultaneous esophageal contractions < 40 mm Hg Or no apparent esophageal contractions Manometric features of DES Required - Simultaneous contractions in >10% of wet swallows - Mean simultaneous contraction amplitude >30 mm Hg Not required - Spontaneous contractions - Repetitive contractions - Multiple peaked contractions - Intermittent normal peristalsis If incomplete relaxation of LES is associated Better classified as atypical disorder of LES relaxation Manometric features of nutcracker esophagus Required Mean distal esophageal peristaltic wave amplitude >180 mm Hg (average amplitude of 10 swallows at 2 recording sites positioned 3 & 8 cm above LES) Not required: Peristaltic contractions of long duration found commonly (> 6 sec) Resting pressure in LES is usually normal but may be elevated In this case: nutcracker esophagus + hypeensive LES ref : bailey and love 27th ed