A unique esophageal motor pattern that involves longitudinal muscles is responsible for emptying in achalasia esophagus.
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.
Hong
Su Jin
SJ
Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea.
Bhargava
Valmik
V
Jiang
Yanfen
Y
Denboer
Debbie
D
Mittal
Ravinder K
RK
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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