Effect of Cold Water on Esophageal Motility in Patients With Achalasia and Non-obstructive Dysphagia: A High-resolution Manometry Study.
OBJECTIVE
Swallowing of cold liquids decreases amplitude and velocity of peristalsis in healthy subjects, using standard manometry. Patients with achalasia and non obstructive dysphagia may have degeneration of sensory neural pathways, affecting motor response to cooling. To elucidate this point, we used high-resolution manometry.


METHODS
Fifteen healthy subjects, 15 non-obstructive dysphagia and 15 achalasia patients, after pneumatic dilation, were studied. The 3 groups underwent eight 5 mL single swallows, two 20 mL multiple rapid swallows and 50 mL intraesophageal water infusion (1 mL/sec), using both water at room temperature and cold water, in a randomized order.


RESULTS
In healthy subjects, cold water reduced distal contractile integral in comparison with water at room temperature during single swallows, multiple rapid swallows and intraesophageal infusion (ratio cold/room temperature being 0.67 [95% CI, 0.48-0.85], 0.56 [95% CI, 0.19-0.92] and 0.24 [95% CI, 0.12-0.37], respectively). A similar effect was seen in non-obstructive dysphagia patients (0.68 [95% CI, 0.51-0.84], 0.69 [95% CI, 0.40-0.97] and 0.48 [95% CI, 0.20-0.76], respectively), whereas no changes occurred in achalasia patients (1.06 [95% CI, 0.83-1.29], 1.05 [95% CI, 0.77-1.33] and 1.41 [95% CI, 0.84-2.00], respectively).


CONCLUSIONS
Our data suggest impairment of esophageal reflexes induced by cold water in patients with achalasia, but not in those with non obstructive dysphagia.
Gastrointestinal Unit 2, Università degli Studi of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Alessandra
A
Elvevi
Gastrointestinal Unit 2, Università degli Studi of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Ivana
I
Bravi
Gastrointestinal Unit 2, Università degli Studi of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Aurelio
A
Mauro
Gastrointestinal Unit 2, Università degli Studi of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Delia
D
Pugliese
Gastrointestinal Unit 2, Università degli Studi of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Andrea
A
Tenca
Department of Clinical Science and Community Health, Università degli Studi of Milan, Italy.
Ivan
I
Cortinovis
Department of Clinical Science and Community Health, Università degli Studi of Milan, Italy.
Silvano
S
Milani
Gastrointestinal Unit 2, Università degli Studi of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Dario
D
Conte
Gastrointestinal Unit 2, Università degli Studi of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Roberto
R
Penagini
Deglutition disorders; Esophageal achalasia; High-resolution manometry