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. 2001 Dec;49(6):813–821. doi: 10.1136/gut.49.6.813

Prolonged manometric recordings of oesophagus and lower oesophageal sphincter in achalasia patients

M A van Herwaarden 1, M Samsom 1, A Smout 1
PMCID: PMC1728547  PMID: 11709516

Abstract

BACKGROUND AND AIMS—Conventional short term manometry is a valuable tool in the diagnosis of achalasia but the technique may fail to detect intermittent motor events. The aim of this study was to investigate the pattern of lower oesophageal sphincter (LOS) and oesophageal pressures during prolonged recording in patients with achalasia.
METHODS—Eleven patients with idiopathic achalasia were studied. Prolonged combined oesophageal pH and manometric recordings of the pharynx, LOS, and stomach were performed using a pH glass electrode and a multiple lumen assembly incorporating a Dent sleeve connected to a portable water perfused manometric system.
RESULTS—LOS pressure varied during the day. Postprandial LOS pressures were lower than those recorded preprandially (1.2 v 1.8 kPa; p=0.005) and basal LOS pressures were significantly higher during phase III of the migrating motor complex than during the subsequent phase I (3.3 v 1.8 kPa; p=0.028). Complete LOS relaxations were occasionally observed in seven patients (0.48/h). Complete LOS relaxations were longer in duration than incomplete LOS relaxations (10.8 v 2.8 s; p=0.01) and 57% of complete relaxations fulfilled the criteria of a transient LOS relaxation (TLOSR). Complete LOS relaxations were associated with oesophageal pressure waves with higher amplitudes and longer durations. In addition, a higher proportion of these oesophageal pressure waves were spontaneous (55.6% v 0%; p<0.02) and multipeaked (72.7% v 0%). During prolonged manometry, high amplitude oesophageal pressure waves (>10 kPa) were recorded in six patients and retrograde oesophageal pressure waves in four, phenomena which were not observed during short term manometry.
CONCLUSION—In contrast with short term stationary manometry, prolonged manometry in achalasia patients revealed the occurrence of complete LOS relaxations, TLOSRs, variations in LOS pressure associated with a meal or phase III, and high amplitude and retrograde oesophageal pressure waves.


Keywords: achalasia; lower oesophageal sphincter; manometry; oesophagus

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Figure 1  .

Figure 1  

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Effect of a liquid nutrient meal on basal lower oesophageal sphincter (LOS) pressure. Basal LOS pressures were significantly lower after the meal than those recorded during the one hour period preceding the meal.

Figure 2  .

Figure 2  

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Typical example of basal lower oesophageal sphincter (LOS) pressure during phase III of the migrating motor complex cycle. The signal obtained from the intragastric sidehole shows a 3/minute rhythm. Intragastric pressure peaks exceed basal LOS pressure. Basal LOS pressure is higher during phase III than during the subsequent phase I. 

Figure 3  .

Figure 3  

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Effect of migrating motor complex (MMC) cycle activity on basal lower oesophageal sphincter (LOS) pressure. LOS pressure was significantly higher during phase III of the MMC cycle than during the 15 minute period afterwards (phase I).

Figure 4  .

Figure 4  

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Example of a complete lower oesophageal sphincter (LOS) relaxation. This complete LOS relaxation was associated with a common cavity phenomenon and a high amplitude pressure wave (34.2 kPa) in the distal oesophagus. Several subsequent swallows were not followed by oesophageal pressure waves or LOS relaxation.

Figure 5  .

Figure 5  

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Transient lower oesophageal sphincter (LOS) relaxation. This relaxation met the criteria of a transient LOS relaxation.

Figure 6  .

Figure 6  

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Amplitudes of oesophageal pressure waves during short term and prolonged manometry and of those associated with a complete lower oesophageal sphincter (LOS) relaxation. Oesophageal pressure waves associated with complete LOS relaxations had a higher amplitude in the proximal, mid, and distal oesophagus compared with amplitudes during short term and prolonged manometric recording. (*p<0.02 v prolonged manometry; †p<0.03, ††p< 0.05 v short term manometry).

Figure 7  .

Figure 7  

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Example of a retrograde oesophageal pressure wave.

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