Fig. 1. Diagnostic algorithm in patients with suspected esophageal motility disorders. All dysphagia patients should be investigated with a prompt endoscopy to exclude obstruction due to mechanical/organic diseases, including esophageal cancer. Even with a normal endoscopic evaluation, differential esophageal biopsies should be obtained to exclude eosinophilic esophagitis (EoE). The presence of a disorder of the outflow obstruction is confirmed by the presence of a persistently raised integrated relaxation pressure (IRP) at supine and upright swallows and on provocative tests at high-resolution manometry (HRM) study. The presence and the severity of the obstruction should also be confirmed by additional diagnostic tests (functional luminal imaging probe [FLIP] and timed barium esophagogram [TBE]) prior to referring patients to treatment. EGJOO, esophagogastric junction outflow obstruction; GI, gastrointestinal.
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