Esophageal pressure topography phenotypes of abnormal propagation

Panel A illustrates a premature contraction defined by a DL of <4.5 s with a normal IRP, the defining feature of DES in the Chicago classification. In this example the CFV is also markedly abnormal with the upper limit of normal being 9 cm/s. Panel B also illustrates a premature contraction, but in this case the CFV is normal. In Panel C, there is a normal DL but rapid CFV. Note how this is associated with a large (5.5 cm) break in the 30 mmHg isobaric contour and an otherwise normal appearing fragment of peristalsis. Panel C is categorized as borderline motor function in the Chicago classification whereas this would have been defined as DES utilizing conventional manometric criteria.