Article

Digestive Diseases and Sciences

, Volume 46, Issue 9, pp 1937-1942

First online:

Compliance Measurement of Lower Esophageal Sphincter and Esophageal Body in Achalasia and Gastroesophageal Reflux Disease

  • Andrew D. JenkinsonAffiliated withGastrointestinal Physiology Unit, St. Bartholomew's and the Royal London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel
  • , S. Mark ScottAffiliated withGastrointestinal Physiology Unit, St. Bartholomew's and the Royal London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel
  • , Etsuro YazakiAffiliated withGastrointestinal Physiology Unit, St. Bartholomew's and the Royal London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel
  • , Giuseppe FusaiAffiliated withGastrointestinal Physiology Unit, St. Bartholomew's and the Royal London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel
  • , Sharon M. WalkerAffiliated withGastrointestinal Physiology Unit, St. Bartholomew's and the Royal London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel
  • , Sritharan S. KadirkamanathanAffiliated withGastrointestinal Physiology Unit, St. Bartholomew's and the Royal London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel
  • , David F. EvansAffiliated withGastrointestinal Physiology Unit, St. Bartholomew's and the Royal London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel

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Abstract

Little is known about the effect of achalasia and gastroesophageal reflux disease (GERD) on compliance of the esophageal body and the lower esophageal sphincter (LES). Twenty-two patients with achalasia, 14 with GERD, and 14 asymptomatic volunteers were assessed. Recording apparatus consisted of a specially developed PVC bag tied to a compliance catheter, a barostat, and a polygraph. Intrabag pressures were increased incrementally while the bag volume was recorded. In each subject, pressure–volume graphs were constructed for both the esophageal body and LES and the compliance calculated. In achalasia, compliance of the esophageal body was significantly higher (P < 0.01) than in controls, whereas LES compliance was similar. Patients with GERD had a highly compliant LES in comparison to both controls and to patients with achalasia (P < 0.01 and P < 0.001, respectively); however there was no difference in their esophageal body compliance. In conclusion, foregut motility disorders can cause changes in organ compliance that are detectable using a barostat and a suitably designed compliance bag. Further measurement of compliance may provide clues to the pathogenesis of these disorders.

achalasia gastroesophageal reflux disease compliance lower esophageal sphincter