Multiple rapid swallowing in idiopathic achalasia: evidence for patients' heterogeneity.

Full Abstract

In order to evaluate the function of inhibitory neural pathways in achalasia, we compared the response of the oesophageal body and lower oesophageal sphincter (LOS) to single swallows (SS) and multiple rapid swallowing (MRS) in 20 consecutive patients with untreated idiopathic achalasia (10 men, aged 23-81 years) and in 20 control patients without dysphagia (nine men, aged 31-73 years), using sleeve manometry; 277 SS and 85 MRS were analysed. In the control group, MRS inhibited motor activity in the oesophageal body and induced a slightly lower (P < 0.05) nadir LOS pressure compared with SS. In the achalasia patients, MRS induced a variable response:
eight patients had simultaneous motor activity during all MRS although onset was delayed compared with SS [median (interquartile range), 3.5 s (1.7-6.1) vs 1.4 s (0.8-3.9); P < 0.05], whereas eight patients showed motor inhibition which occurred during all MRS in four of them, and the remaining four had no motor activity both after SS and during MRS. Overall MRS did not decrease nadir LOS pressure compared with SS [12 mmHg (5-20) vs 16 mmHg (7-22); P > 0.1]; however, it induced complete LOS relaxation in three of the patients. MRS gives further evidence of functional heterogeneity among achalasia patients.

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Author information

Author/s: Savojardo, D (D); Mangano, M (M); Cantù, P (P); Penagini, R (R);

Affiliation: Cattedra di Gastroenterologia, Dipartimento di Scienze Mediche, University of Milan-Ospedale Maggiore, Mangiagalli, Regina Elena, Fondazione IRCCS, Milan, Italy.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society (Neurogastroenterol Motil), published in England. (Language: eng)

Reference: 2007-Apr; vol 19 (issue 4) : pp 263-9

Dates: Created 2007/03/29; Completed 2007/08/01; Revised 2007/11/07;

PMID: 17391242, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Neurogastroenterol Motil. 2007 Sep;19(9):780-1; author reply 782. (PMID: 17727398)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Aged
Aged, 80 and over
Deglutition - drug effects; physiology
Deglutition Disorders - physiopathology
Esophageal Achalasia - physiopathology
Esophagus - drug effects; physiology; physiopathology
Female

Female
Humans
Hydrogen-Ion Concentration
Ketamine - pharmacology
Male
Manometry - methods
Middle Aged
Reference Values

Associated Chemicals: Ketamine (6740-88-1)

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