Radiographic and manometric correlation in achalasia with apparent relaxation of the lower esophageal sphincter

Ott, David J.; Richter, Joel E.; Chen, Yu Men; Wu, Wallace C.; Gelfand, David W.; Castell, Donald O.

doi:10.1007/bf01889144

Cited by 24 publications

(15 citation statements)

References 15 publications

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“…The radiologic appearance of the esophagogastric junction did not differ between these patients and patients with typical achalasia [11]. This indicates that, compared to radiologic investigation, manometric assessment of relaxation patterns more accurately reflects lower esophageal sphincter function.…”

Section: Discussionmentioning

confidence: 84%

Motility changes in primary achalasia following pneumatic dilatation

1990

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The changes in esophageal motility after pneumatic dilatation were evaluated prospectively in 51 patients with achalasia. The patients were evaluated for a median of 14 months. Pneumatic dilatation led to a clinical improvement in 41 patients. On manometric evaluation, a significant decrease in lower esophageal sphincter pressure was observed (28.4 +/- 14.9 mmHg vs. 13.5 +/- 7.2 mmHg; p = 0.001); the resting pressure of the esophageal body dropped from 4.8 +/- 4.2 mmHg above gastric baseline to 0.1 +/- 3.9 mmHg below gastric baseline. After therapy, peristaltic activity was present in 10/51 (20%) patients; in 1 case, complete relaxation of the lower esophageal sphincter was recorded. Treatment-induced motility changes could not be predicted by clinical history or the lower esophageal sphincter pressure before or after therapy. However, the resting pressure of the esophageal body before and after therapy was significantly lower in these patients in whom peristalsis recurred after therapy than in patients with an unchanged motility pattern. The reappearance of peristaltic activity after pneumatic dilatation was unrelated to lower esophageal sphincter pressure. In conclusion, motility disturbances of the esophageal body in patients with achalasia do not simply reflect the functional obstruction of the lower esophageal sphincter. These findings support the hypothesis that achalasia is not a distinct motility disturbance but should be regarded as part of a broad spectrum of different interrelated esophageal motility disorders.

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Section: Discussionmentioning

confidence: 84%

Motility changes in primary achalasia following pneumatic dilatation

1990

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“…For example, several investigators have found that 20-30% of patients with achalasia diagnosed on barium studies had normal relaxation of the lower esophageal sphincter on manometry [15,16]. Because of discrepancies between the radiographic and manometric findings, the precise classification of these motility disorders remains in doubt for some of our patients.…”

Section: Discussionmentioning

confidence: 96%

Relationship Between Diffuse Esophageal Spasm and Lower Esophageal Sphincter Dysfunction on Barium Studies and Manometry in 14 Patients

Prabhakar

Levine

Rubesin

et al. 2004

American Journal of Roentgenology

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“…11 A poorly functioning LES that fails to relax completely during swallowing and a complete absence of primary esophageal peristalsis are considered to be the essential manometric criteria for a diagnosis of achalasia. 12,13 Patients with this disorder may also have a hypertensive LES and other gastrointestinal tract motility abnormalities. The etiology and primary neuralgic defect responsible for the development of achalasia remains poorly defined at present.…”

Section: Discussionmentioning

confidence: 99%

Electrical stimulation of the vagus nerve restores motility in an animal model of achalasia

Khajanchee

VanAndel

Jobe

et al. 2003

Journal of Gastrointestinal Surgery

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Esophageal peristalsis generally does not return to normal after surgical treatment of achalasia. Direct electrical stimulation of the vagus nerve is known to stimulate antegrade peristalsis in the normal esophagus; however, it is not known whether electrical stimulation will induce return of peristalsis once an achalasia-like disorder has been established. The objective of this study was to perform quantitive and qualitative measurements of motility during electrical stimulation of the vagal nerve in an animal model of achalasia. An already established and verified animal achalasia model using adult North American opossums (Didelphis virginiana) was used. Fifteen opossums were divided into three groups. Sham surgery was performed on three animals (group 1). In group 2 (n=6) a loose Gore-Tex band (110% of the esophageal circumference) was placed around the gastroesophageal junction to prevent relaxation of the lower esophageal sphincter during swallowing. In group 3 (n=6) a relatively tighter band (90% of the esophageal circumference) was used to further elevate the lower esophageal sphincter pressure. At 6 weeks, after manometric and radiolologic confirmation of achalasia, electrical stimulation of the esophagus was performed before and after removal of the band using a graduated square-wave electrical stimulus. Changes in esophageal neural plexi were assessed histologically. Pre- and postoperative manometric data were compared using standard statistical techniques. No difference was observed in esophageal characteristics and motility after sham surgery in group 1. Animals in group 2 demonstrated a vigorous variety of achalasia (high-amplitude, simultaneous, repetitive contractions), moderate esophageal dilatation, and degeneration of 40% to 60% of intramuscular nerve plexi. Animals in group 3 developed amotile achalasia with typical low-amplitude simultaneous (mirror image) contractions, severely dilated ("bird beak") esophagus, and degeneration of 50% to 65% of nerve plexi. Vagal stimulation in group 2 demonstrated a significant increase in the amplitude of contractions (P<0.001) and return of peristaltic activity in 49% of swallows before band removal. After band removal, all of the contractions were peristaltic. In group 3 vagal stimulation before and after removal of the band demonstrated a significant increase in amplitude of contractions (P<0.0001) but no return of propagative peristalsis before band removal, however, 44% of contractions were progressive in the smooth portion of the esophagus after removal of the band. Electrical stimulation of the vagus nerve improved the force of esophageal contractions irrespective of the severity of the disease; however, peristaltic activity completely returned to normal only in the vigorous (early) variety of achalasia. Removal of the functional esophageal outlet obstruction, as with a surgical myotomy, may be necessary to obtain significant peristalsis with vagal pacing in severe achalasia.

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Radiographic and manometric correlation in achalasia with apparent relaxation of the lower esophageal sphincter

Cited by 24 publications

References 15 publications

Motility changes in primary achalasia following pneumatic dilatation

Motility changes in primary achalasia following pneumatic dilatation

Relationship Between Diffuse Esophageal Spasm and Lower Esophageal Sphincter Dysfunction on Barium Studies and Manometry in 14 Patients

Electrical stimulation of the vagus nerve restores motility in an animal model of achalasia

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