title: A unique esophageal motor pattern that involves longitudinal muscles is responsible for emptying in achalasia esophagus.
abstract: OBJECTIVE
  Achalasia esophagus is characterized by loss of peristalsis and incomplete esophagogastric junction (EGJ) relaxation. We studied mechanisms of esophageal emptying in patients with achalasia using simultaneous high-resolution manometry, multiple intraluminal impedance, and high-frequency intraluminal ultrasonography image recordings.
  
  
  METHODS
  Achalasia was categorized into 3 subtypes, based on the esophageal response to swallows: types 1 and 2 were defined by simultaneous pressure waves of <30 mm Hg and >30 mm Hg, respectively, and type 3 was defined by spastic simultaneous esophageal contractions.
  
  
  RESULTS
  Based on high-resolution manometry, the predominant achalasia pattern of type 2 was characterized by a unique motor pattern that consisted of upper esophageal sphincter contraction, simultaneous esophageal pressure (pan-esophageal pressurization), and EGJ contraction following swallows. High-frequency intraluminal ultrasonography identified longitudinal muscle contraction of the distal esophagus as the cause of pan-esophageal pressurization in type 2 achalasia. Multiple intraluminal impedance revealed that esophageal emptying occurred intermittently (36% swallows) during periods of pan-esophageal pressurization. Patients with achalasia of types 1 and 3 had no emptying or relatively normal emptying during most swallows, respectively.
  
  
  CONCLUSIONS
  In achalasia, esophageal emptying results from swallow-induced longitudinal muscle contraction of the distal esophagus, which increases esophageal pressure and allows flow across the nonrelaxed EGJ.
authors.affiliation: Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.forename: Valmik
authors.initials: V
authors.lastname: Bhargava
authors.forename: Yanfen
authors.initials: Y
authors.lastname: Jiang
authors.forename: Debbie
authors.initials: D
authors.lastname: Denboer
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Mittal
mesh_terms: D017097:Electric Impedance; D004931:Esophageal Achalasia / Q000503:physiopathology*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008365:Manometry; D009119:Muscle Contraction; D012189:Retrospective Studies; D014463:Ultrasonography
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