High-Resolution Manometry Evaluation of the Pharynx and Upper Esophageal Sphincter Motility in Patients with Achalasia.
The motility of the pharynx and upper esophageal sphincter (UES) is still poorly understood. It is also unclear if the motility of this area may be compromised in patients with achalasia. This study aims to evaluate the motility of the pharynx, UES, and proximal esophagus in patients with esophageal achalasia. Sixty patients with achalasia underwent high-resolution manometry (HRM) (52 % females, mean age 54 years). Esophageal dilatation was classified according to the radiologic diameter in Type I (<4 cm): 6 %; Type II (4-7 cm): 36 %; Type III (7-10 cm): 34 %; and Type IV (>10 cm): 24 %. HRM classified 43 % of the patients as Chicago Type I and 57 % as Type II. Manometric parameters were compared to normal values obtained from a previous study in volunteers. The motility of the velopharynx showed short, premature, and hypertonic contraction. The epiglottis also showed hypertonic contraction. The UES had increased residual pressure. Chicago classification Type II patients had higher UES residual pressure (p = 0.03). The degree of esophageal dilatation did not correlate with manometric parameters. Achalasia may affect the motility of the pharyngo-upper esophageal area. The changes observed may represent functional alterations to prevent aspiration, especially in patients with Chicago classification Type II achalasia.
Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
Mariano A
MA
Menezes
Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil. herbella.dcir@epm.br.|Department of Surgery, Escola Paulista de Medicina, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil. herbella.dcir@epm.br.
Fernando A M
FA
Herbella
Department of Surgery, University of Chicago, Chicago, IL, USA.
Marco G
MG
Patti
D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology*; D011312:Pressure
Achalasia; Esophageal motility; High-resolution manometry; Pharynx; Upper esophageal sphincter