Is aperistalsis with complete lower esophageal sphincter relaxation an early stage of classic achalasia?
BACKGROUND
Aperistalsis with complete lower esophageal sphincter (LES) relaxation, characterized by the complete relaxation of the LES and aperistalsis of the esophageal body on manometry, has been considered by some authors to be an early manifestation of classic achalasia, which is defined as incomplete relaxation of the LES and aperistalsis of the esophageal body. The aim of the present study was to compare the clinical features of patients with aperistalsis with complete LES relaxation, with those of patients with classic achalasia.


METHODS
Eighteen patients with aperistalsis with complete LES relaxation and 53 patients with classic achalasia were analyzed with regard to clinical history, the maximal diameter of the esophageal body on barium esophagogram, LES resting pressure and the duration of LES relaxation on manometric recordings, and the selected treatment and its efficacy.


RESULTS
The aperistalsis with complete LES relaxation group had distinctly different features compared to those of the classic achalasia group including older age, more frequent association with non-cardiac chest pain, less frequent association with dysphagia and weight loss, lower LES resting pressures, and longer duration of LES relaxation. However, the two groups were similar in terms of maximal diameter of the esophageal body, and efficacy associated with pneumatic dilation.


CONCLUSIONS
Aperistalsis with complete LES relaxation on manometry is not necessarily an early manifestation of classic achalasia. However, this condition does not preclude a diagnosis of achalasia or a good response to achalasia therapy.
Kim
Jeong Hwan
JH
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Rhee
Poong-Lyul
PL
Lee
Sang Soo
SS
Lee
Hyuk
H
Choi
Yong Sung
YS
Son
Hee Jung
HJ
Kim
Jae J
JJ
Rhee
Jong Chul
JC
D000328:Adult; D002404:Catheterization; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000503:physiopathology*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009126:Muscle Relaxation / Q000502:physiology*; D010528:Peristalsis / Q000502:physiology*; D011859:Radiography; D012189:Retrospective Studies