Relationship between esophageal muscle thickness and intraluminal pressure in patients with esophageal spasm

Abstract

. Relationship between esophageal muscle thickness and intraluminal pressure in patients with esophageal spasm. Am J Physiol Gastrointest Liver Physiol 282: G1016-G1023, 2002 10.1152/ ajpgi.00365.2001.-We previously showed, in normal subjects, a positive correlation between the esophageal contraction amplitude and peak muscle thickness. The goal of this study was to determine the relationship between esophageal muscle thickness and contraction amplitude in patients with highamplitude peristaltic and simultaneous contractions. Eleven patients with high-amplitude peristaltic contractions, 8 with diffuse esophageal spasm (DES), 7 with nonspecific (NS) motor disorder of the esophagus, and 10 normal subjects were studied using simultaneous pressure and ultrasound imaging. Pressure was recorded by manometry and ultrasound imaging with a high-frequency ultrasound probe catheter. Recordings were performed in the lower esophageal sphincter (LES) and at 2, 4, 6, 8, and 10 cm above the LES during resting state and swallow-induced contractions. Baseline esophageal muscle was thicker in the distal, compared with the proximal esophagus both in normal subjects and patient groups. Patients with DES and nutcracker esophagus (NC) have a higher baseline muscle thickness compared with normal and NS patients. Correlation between the peak pressure and the peak muscle thickness was weaker in patients with NC and DES compared with normal subjects and patients with NS. Whereas normal subjects have good correlation between delta (difference between peak and baseline) muscle thickness and peak pressures, this relationship was absent in patients with NC and DES. Increase in contraction amplitude in patients with NC and DES was associated with an increase in baseline thickness of esophageal muscularis propria. Increase in baseline thickness was specific to patients with spastic motor disorders and was not seen in patients with NS.

Function of longitudinal бvs�� circular muscle fibers in esophageal peristalsis, deduced with mathematical modeling

“…These results support the physiological explanation of longitudinal muscle function discussed above, since a higher degree of LLS would imply a higher concentration of circular muscle fibers and, potentially, a higher closure pressure (equation 1, Figure 4). Pehlivanov et al [23] went on to show that this correlation weakens in patients with nutcracker esophagus and diffuse esophageal spasm, suggesting that pathology of circular and longitudinal muscle during bolus transport may be intertwined. Interestingly, Balaban et al [24] demonstrated a correlation in thickening of the esophageal muscularis propria sustained for a minute and chest pain, in the absence of peristalsis and circular muscle contraction.…”

Distal Esophageal Spasm

“…Recent observations by Pehlivanov et al [7] using high-frequency intraluminal ultrasound suggest that there is increased esophageal smooth muscle thickness in DES patients. Even in the absence of esophageal contractions, the muscularis propria was thicker in DES patients than in controls and patients with nonspecific motor disorders.…”

Esophageal Hypomotility and Spastic Motor Disorders: Current Diagnosis and Treatment

“…Studies combining esophageal manometry and high-frequency ultrasound have shown the presence of hypertrophy of the muscularis propria in patients with hypertensive contractions [15,25]. Asynchrony between the circular and longitudinal esophageal muscle contractions has also been demonstrated in patients with NE [25,26].…”

“…Unfortunately, there are scarce histopathologic studies from patients with DES, and the findings are nonspecific [13,14]. Studies with endoscopic ultrasound have shown that patients with DES have a thicker muscularis propria layer than controls [14,15]. Also, 31-33 % of cases with DES demonstrate GERD [4•,16].…”