EX PERIMENTAL STUDY ON THE PATHOGENESIS OF ACHALASIA

The pathognesis of achalasia has not yet been entirely clarified. The author undertook animal experiments in order to study the role of the central nervous system concerning the pathognesis. In 49 adult eats, destructive lesions were made bilaterally in the hypothalamus either with carbolic acid (Phenol) or with electrocoagulation. In those cats that had survived for more than 7 days, the esophageal movements were studied with X-ray, electromyogram and intraluminal pressure curve, and the extent of the hypothalamic lesions was identified histologically by serial sections. Seven eats were used as controls.The 10% phenol solution was injected into 8 animals among which 7 survived for more than 7 days. Serial sections performed in 2 cats did not disclose any destructive lesions in which cases any signs of diglutition or any X-ray abnormalities of the esophagus could not be observed.Electrocoagulation was used to make lesions in 34 cats among which 24 survived for more than 7 days. Serial sections revealed lesions involving the ventromedial nucleus of the hypothalamus bilaterally in 3 cats which showed signs of diglutition and radiographie evidence of passage disturbance of the esophagus. In contrast, in those 17 cats in which the lesion failed to involve the ventromedial nucleus, no signs of diglutition or motion disturbance of the sophagus were observed.It is thus possible to produce achalasia in cats by bilateral electrocoagulation of the ventromedial nucleus of the hypothalamus. This suggests the possible role of the central nervous system in the pathognesis of achalasia.