| SWS diagnosis | Abnormal adjunctive swallows* | Defining features of this group | Recommendations | Follow-up |
| Normal (5/100) | § Impaired IRP (n = 2) § Short DL (n = 3) | § None | § Gastroscopy of EGJ for the patients with impaired IRP | § Negative gastroscopy (n = 3) § No follow-up available (n = 2) |
| Normal with dysphagia symptoms (12/70) | § Impaired IRP (n = 6) § Short DL (n = 2) § Impaired IRP and short DL (n = 4) | § Ten of 12 (92%) patients had at least one SWS with abnormal IRP or DL but did not meet CCv3.0 criteria for motility disorder diagnosis. § Nine of 12 (75%) patient had reported dysphagia symptoms exclusively or much worse with semi-solid or solid swallows. § Three of 12 (25%) patients had non-specific abnormalities during SWS; oesophagus shortening, pan-pressurisation, abnormal swallow morphology | § Gastroscopy of EGJ for the patients with impaired IRP (n = 6) § Repeat HRM in 12 month or with worsening symptoms (n = 2) § Trial of nitrates or calcium channel blockers for patients with short DL (spasm features n = 4) | § EGJ thickening noted by gastroscopy (n = 2, Figure 2) § Eosinophilic esophagitis diagnosed by gastroscopy (n = 1) § Trial of nitrates alleviated some symptoms (n = 2) § Negative gastroscopy (n = 2) § No follow-up available (n = 5) |
| Ineffective motility (1/30) | § Impaired IRP (n = 1) | § Two SWS with IRP > 15 mmHg | § Repeat HRM in 12 month or with worsening symptoms | § Repeat HRM revealed swallow morphology characteristic of type II achalasia in all swallow types (Figure 3). |
| Jackhammer (5/30) | § Impaired IRP (n = 5) | § All patients had at least one SWS with impaired IRP but did not meet CCv3.0 criteria for motility disorder diagnosis. § Three of 5 (60%) patients with mean SWS-IRP on the upper end of normal (>12 mmHg) § Elevated mean intrabolus pressure in SWS | § Diagnosis of evolving type III achalasia and trial of calcium channel blockers/nitrates (n = 4) § Diagnosis of type III achalasia and recommended barium swallow to confirm (n = 1) | § Underwent POEM, significantly reduced symptoms post-surgery (n = 1) § Barium swallow/ gastroscopy provided additional evidence suggestive of evolving achalasia (n = 3) § Nitrates in combination with pneumatic dilation alleviated some symptoms (n = 1) |
| Oesophageal spasm (4/30) | § Impaired IRP (n = 4) | § Two of 4 (50%) patients had at least one SWS with impaired IRP but did not meet CCv3.0 criteria for motility disorder diagnosis. | § Diagnosis of evolving type III achalasia and trial of calcium channel blockers/nitrates (n = 3) § Diagnosis of type III achalasia and recommended barium swallow to confirm (n = 1) | § Confirmed evolving achalasia with barium swallow/gastroscopy (n = 1) § Underwent POEM, significantly reduced symptoms post-surgery (n = 1, Figure 4) § Calcium channel blockers alleviated some symptoms (n = 1) § No follow-up available (n = 1) |
| EGJ outflow obstruction (3/30) | § Short DL (n = 3) | § All patients had at least one SWS with short DL, rapid contractile front velocity. § All patients had at least one SWS with abnormally high focal area of contractility in the peristaltic body. | § Gastroscopy of EGJ for possible stricture (n = 3) | § Pneumatic dilation, initial symptom relief but returned after several weeks (n = 1) § No follow-up available (n = 2) |