Anorectal motility in patients with achalasia of the esophagus: recognition of an esophago-rectal syndrome.
BACKGROUND
During my study of constipation, I encountered patients who had achalasia of the esophagus (AE) as well. The possibility of an existing relationship between the 2 conditions was studied.


METHODS
Investigations to study the anorectal motility in 9 AE patients included: the intestinal transit time, anorectal manometry, rectoanal inhibitory reflex, defecography and electromyography (EMG) of external anal sphincter and levator ani muscle. Anorectal biopsy was done. The study comprised 8 healthy volunteers as controls.


RESULTS
6/9 AE patients had constipation presenting as strainodynia (excessive prolonged straining at stool). Rectocele was present in 4 of them. The 6 constipated patients showed significantly high rectal neck pressure (p < 0.05), absent rectoanal inhibitory reflex and aganglionosis in the anorectal biopsy. The EMG revealed diminished activity in 4 of the 6 constipated patients. The remaining 3 patients with AE had normal anorectal function. Heller's myotomy with Nissen's fundoplication improved the dysphagia, but not the constipation which was, however, relieved after performance of anorectal myectomy.


CONCLUSIONS
The high incidence of constipation with AE postulates a relationship between the 2 conditions. Both have the same pathologic lesion which is aganglionosis. This study is preliminary and requires further studies on a larger number of patients.
Shafik
Ahmed
A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt. shafik@ahmed-shafik.org
D000328:Adult; D001003:Anal Canal / Q000503:physiopathology; D003248:Constipation / Q000150:complications / Q000503:physiopathology*; D003672:Defecation / Q000502:physiology; D004931:Esophageal Achalasia / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D008297:Male; D012007:Rectum / Q000503:physiopathology*; D013577:Syndrome