Table 1.

Disorders of Esophageal Peristalsis

Diagnosis	CC v4.0 Criteria of Normal Median IRP AND:	Additional Considerations
Absent Contractility	100% failed peristalsis	Borderline median IRP values should prompt consideration of type I achalasia, especially if prominent dysphagia
Distal Esophageal Spasm (DES)	≥20% of swallows with premature contraction (distal latency <4.5 seconds) in setting of dysphagia and/or non-cardiac chest pain symptoms	≥20% of swallows with premature contraction but DCI <450 mmHg•s•cm is inconclusive for manometric diagnosis of DES
Hypercontractile Esophagus	≥20% of swallows with hypercontractility (DCI >8000 mmHg•s•cm) in setting of dysphagia and/or non-cardiac chest pain symptoms	Must rule out distal esophageal/EGJ mechanical obstruction; three sub-types (single-peaked hypercontractile swallows, jackhammer with repetitive prolonged contractions, hypercontractile swallows with vigorous LES after-contraction)
Ineffective Esophageal Motility (IEM)	>70% of swallows ineffective (DCI <450 mmHg•s•cm) and/or fragmented (peristaltic break >5 cm in 20 mmHg isobaric contour with normal DCI), or ≥50% swallows failed (DCI <100 mmHg•s•cm)	50–70% of swallows ineffective is inconclusive for diagnosis of IEM and should prompt supportive data (poor bolus transit on impedance or barium esophagram, lack of contraction reserve on multiple rapid swallow sequences)