Repetitive Proximal Esophageal Contractions: A New Manometric Finding and a Possible Further Link Between Parkinson's Disease and Achalasia

Abstract

Repetitive, spontaneous contractions of the proximal esophagus have recently been identified as a feature of achalasia. This article documents similar findings in six patients with Parkinson's disease. Parkinson's disease and achalasia share many common features neurologically. Both have Lewy bodies in the esophageal myenteric plexuses and the substantia nigra, in addition to evidence of degeneration of the dorsal motor nucleus of the vagus. The esophageal features radiologically and manometrically are also similar. Repetitive proximal esophageal contractions may represent another link between these diseases. They have also been reported in scleroderma. We speculate that the common link between all three disease processes may be poor distensibility of the esophagus.

Comprehensive epidemiological and genotype–phenotype analyses in a large European sample with idiopathic achalasia

“…Not surprisingly, Parkinson's disease was one of the few comorbid disorders observed in the study of Sonnenberg et al [6] on achalasia patients aged at least 65 years. The data are also in line with reports of patients with Parkinson's disease and abnormal esophageal motility and achalasia [28][29][30]. Lewy bodies, a characteristic histopathological feature of Parkinson's disease in the brain stem, have also been found in the myenteric plexus of patients with Parkinson's disease and achalasia [31][32][33].…”

Neural control of the gastrointestinal tract: Implications for Parkinson disease

“…Esophageal dysmotility also occurs frequently in PD 48, 59–63. Slowed esophageal transit, aperistalsis, and reduced pressure of the LES may reflect impairment of the vagal motor excitatory pathway, whereas segmental esophageal spasm and achalasia may reflect impairment of the vagal inhibitory pathway.…”

Achalasia and thyroid disease

“…The etiology of primary achalasia is not entirely clear and probably multidimensional [19] including genetic predisposition (supported by the concordance for the disease in monozygotic twins [20] and associations with some HLA loci [7] ), inflammation (myopathy of the smooth muscle cells [21] , neuropathy [22,23] and inflammatory changes in esophageal specimens [24] ), infections (virus [14] , Chagas' disease, poliomyelitis [25,26] , varicella zoster virus [27] and Helicobacter [28] ), ischemia, toxicity and autoimmune disease [19] . Some other diseases postulate these etiologies such as concomitant appearance of achalasia and GuillainBarré syndrome [29] , Parkinson's disease [30] , triple A syndrome [31] , etc. Table 2 Average score of all patients and those suffering from thyroid disease respectively (mean ± SD)…”