Esophageal achalasia--manometric patterns

Abstract

Achalasia is a primary esophageal motility disorder involving the body of the esophagus and lower esophageal sphincter. Esophageal manometry is the gold standard to diagnose achalasia. Two cardinal features are encountered in achalasia: incomplete LES relaxation and absent peristalsis in the lower esophagus. In a group of 94 patients with dysphagia we looked for the manometric changes, trying to identify clinical and manometric particularities of the cases with achalasia. 35 cases had manometric changes compatible with the diagnostic of achalasia. A number of 41 patients had other esophageal motility disorders and 8 patients had normal esophageal manometry. The majority of patients (80%) had an increase basal pressure in the lower esophageal sphincter (LES) and the rest of them had a normal pressure of the LES. Absence of the lower esophageal sphincter relaxation or incomplete relaxation was observed in all cases. Aperistalsis was found in 33 patients (94.3%) and 2 patients (5.7%) presented hyperperistaltism of the tubular esophagus. We followed the manometric changes pre and post treatment in 10 cases, all having similar manometric modifications, before and after treatment; only the basal pressure of the lower esophageal sphincter was modified after treatment.