Clinical features:
(1) retrosternal pain
(2) dysphagia, with paroxysms of crampy pain while eating solid foods
(3) strong esophageal contractions that make passing a tube difficult
(4) corkscrew appearance on barium swallow
Chicago criteria:
(1) mean distal contractile integral (DCI) > 5,000 mm Hg•sec•cm (95
th
percentile for normal)
(2) does not meet criteria for hypercontractile (“jackhammer”) esophagus (at least one contraction > 8,000 mm Hg•sec•cm with normal propragation)
Richter criteria: peristaltic contractions with average amplitude >= 180 mm Hg (based on averaging the amplitudes at 3 and 8 cm above the lower esophageal sphincter [LES]). The threshold is 2 SD above the mean seen in healthy volunteers.
Agrawal criteria: mean distal esophageal amplitude > 220 (or > 260 mm Hg) since these pressures were more likely to be associated with symptoms.
Achem criteria:
(1) > 199 mm Hg at 3 cm above LES
(2) > 172 mm Hg at 8 cm above LES
(3) > 102 mm Hg at 13 cm above LES
The abnormal peristalsis may be segmental (limited to 1 or 2 levels) or diffuse (more than 2 levels).
