Spectrum of Esophageal Motility Disorders on High-Resolution Manometry in Patients With Non-obstructive Dysphagia

Background and objectives Esophageal motility disorders (EMDs) are a major cause of non‑obstructive dysphagia. However, regional data from eastern India are limited. This study aims to describe the spectrum of EMDs in patients with non‑obstructive dysphagia using high‑resolution manometry (HRM) at a tertiary care center in eastern India, and to compare clinical symptoms, and endoscopic and barium findings in patients with achalasia versus non‑achalasia. Methods This cross‑sectional observational study was conducted between August 2023 and March 2025 at a tertiary care center in eastern India. Adult patients with dysphagia underwent HRM after ruling out an obstructive lesion on upper gastrointestinal endoscopy (UGIE). Symptom profile and endoscopic and barium swallow findings were recorded. Descriptive statistics summarized demographic and clinical features. Continuous variables were expressed as mean ± SD, and categorical variables as frequencies/percentages. Chi‑square test, Fisher's exact test, and Mann‑Whitney test were used for inter‑group comparisons. All analyses were two‑tailed, with p < 0.05 considered statistically significant. Data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics (v31.0.0.0). Results A total of 262 patients (mean age 43.6 ± 14.3 years; 57% female) were included. HRM revealed achalasia in 53.9% (Type I: 5.0%, Type II: 46.2%, and Type III: 2.7%), esophagogastric junction outflow obstruction (EGJOO) in 9.1%, ineffective esophageal motility (IEM) in 8.4%, absent contractility in 8.4%, fragmented peristalsis in 1.9%, and normal motility in 17.9%. Dysphagia to both solids and liquids and weight loss were reported by 76.7% and 78.6% of patients, respectively. Gastroesophageal junction (GEJ) resistance was seen on endoscopy in 62.2% and significant barium retention in 67.2%. Univariate analysis showed achalasia patients had significantly higher Eckardt scores (ESs), and more frequent abnormal endoscopic and barium findings. Dysphagia, regurgitation, and weight loss were significantly more common in achalasia (p < 0.001). No significant associations were found for gender, chest pain, or BMI (p > 0.05). Multivariate analysis identified abnormal UGIE findings (including GEJ resistance - with dilated esophagus or retained food) and barium retention at one and five mins on timed barium swallow (TBS) as independent predictors of achalasia. Conclusion Achalasia, especially Type II, is the most prevalent motility disorder in patients with non‑obstructive dysphagia in eastern India. HRM is essential for accurate diagnosis and classification of EMD. This study highlights the need for increased HRM accessibility and early referral for HRM based on achalasia predictors in resource‑limited settings.