Physiology of the Distal Esophagus in Achalasia

Abstract

Intraluminal manometric studies were performed in 30 normal adults and in 16 symptomatic patients with the radiological features of achalasia by the use of a constant catheter perfusion technique. A normotensive gastroesophageal sphincter was found in every patient with achalasia. Sphincteric fall in pressure on swallowing was found in 92.7 per cent of the swallows in 12 of the 16 patients with achalasia. In 4 patients, no fall in sphincteric pressure was recorded on swallowing. A significant increase in resting sphincteric pressure after subcutaneous injection of an acetylcholine derivative is described. 98 per cent of swallows were followed by sphincteric fall in pressure under the action of this agent in all patients tested. The nature of the dynamic abnormality most frequently found in achalasia is discussed. It is concluded that results obtained with the use of a constant catheter perfusion technique during intraluminal pressure measurements should lead to a re-evaluation of currently accepted concepts on the pathophysiology of achalasia.