A CLINICAL AND EXPERIMENTAL STUDY ON THE ESOPHAGEAL MOTILITY IN ESOPHAGEAL ACHALASIA

Eighteen patients with esophageal achalasia were investigated by an esophageal manometry and a mecholyl test in contrast of normals, patients with cancer of the esophagogastric junction and diffuse spasm.Compared with normals, esophageal achalasia showed 1) increased pressure and aperistalsis in the esophagus, 2) increased pressure and impaired relaxation in the lower esophageal sphincter.None of these findings, however, was specific to esophageal achalasia in comparison with the cancer and diffuse spasm. The most specific feature for esophageal achalasia was a positive mecholyl response.Two models of esophageal achalasia were experimentally produced in dogs and a manometric study was performed.A selective destruction of the myenteric plexus in the lower esophagus resulted in the same manometric changes that observed in human esophageal achalasia including a definite response to mecholyl.On the other hand, bilateral thoracic vagotomy produced a temporarily atonic dilatation of the esophagus which differed fundamentally from humans. Mecholyl test was negative in the vagotomy group.These data suggested that the most specific feature of esophageal achalasia is a positive mecholyl response, which testifies to a myenteric degeneration.