title: Hypertrophy of the muscularis propria of the lower esophageal sphincter and the body of the esophagus in patients with primary motility disorders of the esophagus.
abstract: OBJECTIVE
  Patients with diffuse esophageal spasm (DES) and nutcracker esophagus/high amplitude esophageal contraction (HAEC) have a thicker esophageal muscularis propria than do healthy subjects. The goals of this study were to determine the esophageal muscle cross-sectional area (MCSA), a measure of muscle mass, in patients with achalasia of the esophagus; and to compare it with that in patients with DES, patients with HAEC, and normal subjects.
  
  
  METHODS
  Using a high-frequency ultrasound probe catheter, concurrent manometry and ultrasound images of the esophagus were recorded in four subject groups: normal volunteers, patients with HAEC, patients with DES, and patients with achalasia of the esophagus. Recordings were obtained from the lower esophageal sphincter (LES) and multiple sites in the esophagus 2, 4, 6, 8, and 10 cm above the LES.
  
  
  RESULTS
  The LES and esophageal muscle thickness as well as esophageal MCSA were greater in all three patient groups than in the normal subject group. Muscle thickness and MCSA were observed to be greatest in patients with achalasia, which were greater than in patients with DES, which were greater than in those with HAEC, which in turn were greater than in normal subjects.
  
  
  CONCLUSIONS
  We propose that an increase in the MCSA is an important feature of patients with primary motility disorders of the esophagus. The degree of increase in muscle mass may be an important determinant of the type and the severity of esophageal motor dysfunction.
authors.affiliation: Division of Gastroenterology, San Diego Veterans Affairs Medical Center, San Diego, California 92161, USA.
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Mittal
authors.forename: Ghassan
authors.initials: G
authors.lastname: Kassab
authors.forename: James L
authors.initials: JL
authors.lastname: Puckett
authors.forename: Jianmin
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D019412:Anatomy, Cross-Sectional; D015154:Esophageal Motility Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000473:pathology*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography