A high-resolution view of achalasia.
BACKGROUND
High-resolution manometry (HRM) makes it possible to better evaluate spatial and temporal characteristics of esophageal motor function. This technology is revealing new observations regarding disordered motor function in esophageal diseases.


OBJECTIVE
The aim of this study was to define the essential features of achalasia using HRM.


METHODS
We performed HRM on 27 patients with achalasia, 10 patients with gastroesophageal reflux disease, and 10 controls. Ten 5 mL water swallows were recorded with a solid-state manometric assembly incorporating 36 circumferential sensors spaced at 1-cm intervals.


RESULTS
The resting lower esophageal sphincter pressure was greater in achalasia than in controls or gastroesophageal reflux disease. There was an absence of peristalsis in the smooth muscle esophagus and failure of lower esophageal sphincter relaxation. The resting upper esophageal sphincter pressure was not different among the 3 groups. In addition to the typical manometric findings of achalasia, new observations are included. Esophageal shortening, pressurization of the esophagus, and rhythmic contractions of the upper esophageal sphincter and striated muscle esophagus were frequently observed.


CONCLUSIONS
HRM demonstrates alterations of esophageal motor function in achalasia that are not easily observed with other manometric techniques.
Jee
Sam-Ryong
SR
GI Motility Program, Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Pimentel
Mark
M
Soffer
Edy
E
Conklin
Jeffrey L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D010528:Peristalsis; D012189:Retrospective Studies; D055815:Young Adult