title: The appearance of rosette-like esophageal folds ("esophageal rosette") in the lower esophagus after a deep inspiration is a characteristic endoscopic finding of primary achalasia.
abstract: BACKGROUND
  In healthy subjects who inspire deeply the lower esophagus usually opens, and the esophageal palisade vessels (EPVs) become visible. However, in patients with achalasia, the full extent of the EPVs does not become visible and, in addition, rosette-like esophageal folds appear in the lower esophagus. The aim of this study was to investigate whether or not these changes at the lower esophagus are characteristic findings of achalasia.
  
  
  METHODS
  A total of 34 patients with achalasia and no esophageal dilatation following deep inspiration were compared with 34 sex- and age-matched control subjects. Following a deep inspiration, the lower esophagus of all study cohorts was evaluated on (1) whether or not the full extent of the EPVs was visible, (2) whether or not rosette-like esophageal folds appeared in the lower esophagus, and (3) whether or not there were any gastric lesions.
  
  
  RESULTS
  One patient had secondary achalasia, and the remaining 33 patients had primary achalasia. In the control subjects, the full extent of the EPVs was clearly visible after a deep inspiration, and no esophageal folds appeared in the lower esophagus. In contrast, in the achalasia patients, EPVs were not observed in all patients after a deep inspiration, and rosette-like esophageal folds appeared in 33 of the 34 patients.
  
  
  CONCLUSIONS
  After a deep inspiration, the non-visibility of the EPVs and the appearance of rosette-like esophageal folds at the lower esophagus, which we have called "esophageal rosette", are characteristic endoscopic findings of primary achalasia.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Nippon Medical School, Sendagi 1-1-5, Bunkyo-ku, Tokyo 113-8603, Japan. k-iwa@nms.ac.jp
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Iwakiri
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hoshihara
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Kawami
authors.forename: Hirohito
authors.initials: H
authors.lastname: Sano
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Mariko
authors.initials: M
authors.lastname: Umezawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Kotoyori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nomura
authors.forename: Masao
authors.initials: M
authors.lastname: Miyashita
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016145:Endoscopy, Digestive System / Q000379:methods*; D004931:Esophageal Achalasia / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D001239:Inhalation; D008297:Male; D008875:Middle Aged