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Dysfunction of the lower esophageal sphincter in disorders other than achalasia

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Nine patients, all with symptoms of dysphagia and/or substernal chest pain, are described. In 5, radiologic studies of the esophagus were normal, and in none was there an increase in esophageal caliber. Each patient had dysfunction of the lower esophageal sphincter, as assessed by manometry, the chief abnormality being impairment of relaxation in 7, and derangement of contraction in 2. All showed peristaltic activity in the esophageal body during manometric studies. One patient had the classic manometric pattern of diffuse esophageal spasm. In the remainder, some but not all of the manometric features of this disorder were present. These observations serve to emphasize that the boundaries between achalasia, diffuse esophageal spasm, and other less well-characterized disorders of esophageal motility are blurred; and they are consistent with the view that such disorders represent parts of a continuous spectrum.

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  1. 1.

    Fyke FH Jr, Code CF, Schlegel JF: The gastroesophageal sphincter in healthy human beings. Gastroenterologia (Basel) 86:135–150, 1956

  2. 2.

    Atkinson M, Edwards DAW, Honour AJ, Rowlands EM: Comparison of cardiac and pyloric sphincters: a manometric study. Lancet 2:918–922, 1957

  3. 3.

    Botha GSM, Astley R, Carré IJ: A combined cineradiographic and manometric study of the gastroesophageal junction. Lancet 1:659–662, 1957

  4. 4.

    Kelley ML Jr, Wilbur DL III, Schlegel JF, Code CF: Deglutitive responses in the gastroesophageal sphincter in healthy human beings. J Appl Physiol 15:483–488, 1960

  5. 5.

    Kaye MD, Showalter JP: Normal deglutitive responses of the human lower esophageal sphincter. Gut 13:352–360

  6. 6.

    Creamer B, Olsen AM, Code CF: The esophageal sphincters in achalasia of the cardia (cardiospasm). Gastroenterology 34:782–796, 1957

  7. 7.

    Olsen AM, Ellis FH Jr, Creamer B: Cardiospasm (achalasia of the cardia). Am J Surg 93:299–307, 1957

  8. 8.

    Code CF, Creamer B, Schlegel JF, Olsen AM, Donoghue FE, Anderson A: An Atlas of Esophageal Motility in Health and Disease. Springfield, Charles C Thomas, Publisher, 1958

  9. 9.

    Vantrappen G, van Goidsenhoven GE, Berbeke S, van den Berghe G, Vandenbroucke J: Manometric studies in achalasia of the cardia, before and after pneumatic dilations. Gastroenterology 45:317–325, 1963

  10. 10.

    Soergel KH, Zboralske FF, Amberg JR: Presbyesophagus: esophageal motility in nonagenarians. J Clin Invest 43:1472–1479, 1966

  11. 11.

    Sanderson DR, Ellis FH Jr, Schlegel JF, Olsen AM: Syndrome of vigorous achalasia: clinical and physiologic observations. Dis Chest 52:508–517, 1967

  12. 12.

    Lind JF, Blanchard RJ, Guyda H: Esophageal motility in tracheoesophageal fistula and esophageal atresia. Surg Gynecol Obstet 123:557–564, 1966

  13. 13.

    Anderson HA, Schlegel JF, Olsen AM: Postvagotomy dysphagia. Gastrointest Endosc 12:13–18, 1966

  14. 14.

    Pope CE II. Effect of infusion on force of closure measurements in the human esophagus. Gastroenterology 52:779–786, 1967

  15. 15.

    Hollis JB, Castell DO: Amplitude of esophageal peristalsis as determined by rapid infusion. Gastroenterology 63:417–422, 1972

  16. 16.

    Shepherd JK, Diamant NE: Mecholyl test: comparison of balloon kymography and intraluminal pressure measurement. Gastroenterology 63:557–563, 1972

  17. 17.

    Dagradi AE, Stempien SJ, Seifer HW, Weinberg JA: Terminal esophageal (vestibular) spasm after vagotomy. Arch Surg 85:955–968, 1962

  18. 18.

    Edwards DAW: Post-vagotomy dysphagia. Lancet 2:90–92, 1970

  19. 19.

    Elebute E, Kelley ML Jr, Schwartz SI: Pressure effects of transabdominal supradiaphragmatic vagotomy on the inferior esophageal sphincter of dogs. Surg Gynecol Obstet 123:326–332, 1966

  20. 20.

    Crispin JS, McIver DK, Lind JF: Manometric study of the effect of vagotomy on the gastroesophageal sphincter. Can J Surg 10:299–302, 1967

  21. 21.

    Blackman AH, Rakatansky H, Nasrullah M, Thayer WR: Transabdominal vagectomy and lower esophageal function. Arch Surg 102:6–8, 1971

  22. 22.

    Kramer P, Fleshler B, McNally E, Harris LD: Esophageal sensitivity to Mechanolyl in symptomatic diffuse spasm. Gut 8:120–127, 1967

  23. 23.

    Gillies M, Nicks R, Skyring A: Clinical, manometric and pathological studies in diffuse esophageal spasm. Br Med J 2:527–530, 1967

  24. 24.

    Creamer B: Motor disturbances of the esophagus, Handbook of Physiology. Sect 6: Alimentary Canal; Vol IV: Motility. Baltimore, Waverly Press Inc, 1968, pp 2331–2343

  25. 25.

    Creamer B, Donoghue FE, Code CF: Pattern of esophageal motility in diffuse spasm. Gastroenterology 34:782–796, 1958

  26. 26.

    Roth HP, Fleshler B: Diffuse esophageal spasm: clinical radiological and manometric observations. Ann Intern Med 61:914–923, 1964

  27. 27.

    Code CF, Schlegel JF, Kelley ML Jr, Olsen AM, Ellis FH Jr: Hypertensive gastroesophageal sphincter. Proc Mayo Clin 35:391–399, 1960

  28. 28.

    Ellis FH, Code CF, Olsen AM: Long esophagotomy for diffuse spasm of the esophagus and hypertensive gastroesophageal sphincter. Surgery 48:155–169, 1960

  29. 29.

    Schatzki R: Reliefstudien an der normalen und krankhaft veranderten speiserohre. Acta Radiol (Stockholm) Suppl 18: 1933

  30. 30.

    Craddock DR, Logan A, Walbaum PR: Diffuse esophageal spasm. Thorax 21:511–517, 1966

  31. 31.

    Bennett JR, Hendrix TR: Diffuse esophageal spasm: a disorder with more than one cause. Gastroenterology 59:273–279, 1970

  32. 32.

    Olsen AM, Creamer B: Studies of esophageal motility, with special reference to the differential diagnosis of diffuse spasm and achalasia (cardiospasm). Thorax 12:279–289, 1957

  33. 33.

    Code CF: The physiologic basis of some disorders of motor function of the esophagus. Postgrad Med 26:265–271, 1959

  34. 34.

    Ellis FH Jr, Olsen AM: Achalasia of the esophagus. Philadelphia, W.B. Saunders Co, 1969

  35. 35.

    Kramer P Harris LD, Donaldson RM Jr: Transition from symptomatic diffuse spasm to cardiospasm. Gut 8:115–119, 1967

  36. 36.

    Barrett NR: Achalasia of the cardia: reflections upon a clinical study of over 100 cases, Br Med J 1:1135–1140, 1964

  37. 37.

    Schroder S, Achord JL, Rogers JV Jr: Achalasia preceded by non-cardiospastic diffuse esophageal spasm: a cineradiographic study (Abstr). Gastroenterology 44:849, 1963

  38. 38.

    Hogan WJ, Caflisch CR, Winship DH: Unclassified motor disorders simulating achalasia. Gut 10:234–240, 1969

  39. 39.

    Kramer P, Ingelfinger FJ: Esophageal sensitivity to Mecholyl in cardiospasm. Gastroenterology 19:242–253, 1957

  40. 40.

    Hightower NC Jr, Olsen AM, Moersch HJ: A comparison of the effects of acetyl-beta-methacholine chloride (Mecholyl) on esophageal intraluminal pressure in normal persons and patients with cardiospasm. Gastroenterology 26:592–600, 1954

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Correspondence to Dr. Michael D. Kaye MA, DM, MRCP.

Additional information

This work was supported in part by Grant AM 05122 from the National Institutes of Health.

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Kaye, M.D. Dysfunction of the lower esophageal sphincter in disorders other than achalasia. Digest Dis Sci 18, 734–745 (1973).

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  • Public Health
  • Chest Pain
  • Continuous Spectrum
  • Achalasia
  • Lower Esophageal Sphincter