Journal of Gastrointestinal Surgery

, Volume 19, Issue 10, pp 1753–1757 | Cite as

High-Resolution Manometry Evaluation of the Pharynx and Upper Esophageal Sphincter Motility in Patients with Achalasia

  • Mariano A. Menezes
  • Fernando A. M. Herbella
  • Marco G. Patti
Original Article


The motility of the pharynx and upper esophageal sphincter (UES) is still poorly understood. It is also unclear if the motility of this area may be compromised in patients with achalasia. This study aims to evaluate the motility of the pharynx, UES, and proximal esophagus in patients with esophageal achalasia. Sixty patients with achalasia underwent high-resolution manometry (HRM) (52 % females, mean age 54 years). Esophageal dilatation was classified according to the radiologic diameter in Type I (<4 cm): 6 %; Type II (4–7 cm): 36 %; Type III (7–10 cm): 34 %; and Type IV (>10 cm): 24 %. HRM classified 43 % of the patients as Chicago Type I and 57 % as Type II. Manometric parameters were compared to normal values obtained from a previous study in volunteers. The motility of the velopharynx showed short, premature, and hypertonic contraction. The epiglottis also showed hypertonic contraction. The UES had increased residual pressure. Chicago classification Type II patients had higher UES residual pressure (p = 0.03). The degree of esophageal dilatation did not correlate with manometric parameters. Achalasia may affect the motility of the pharyngo-upper esophageal area. The changes observed may represent functional alterations to prevent aspiration, especially in patients with Chicago classification Type II achalasia.


Achalasia High-resolution manometry Esophageal motility Pharynx Upper esophageal sphincter 


Conflict of Interest

Authors declare that they have no competing interests.

Author’s Contribution

MAM and FAMH did the conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published. MGP did the review for intellectual content and final approval of the version to be published.


  1. 1.
    Silva LC, Herbella FAM, Neves LR, Vicentine FPP, Neto SP, Patti MG. Anatomophysiology of the pharyngo-upper esophageal area in light of high-resolution manometry. J Gastrointest Surg 2013; 17:2033–2038.CrossRefPubMedGoogle Scholar
  2. 2.
    Takasaki K, Umeki H, Enatsu K, Tanaka F, Sakihama N, Kumagami H, Takahashi H. Investigation of pharyngeal swallowing function using high-resolution manometry. Laryngoscope 2008; 118:1729–1732.CrossRefPubMedGoogle Scholar
  3. 3.
    Weijenborg PW, Kessing BF, Smout AJPM, Bredenoord AJ. Normal values for solid-state esophageal high-resolution manometry in a European population; an overview of all current metrics. Neurogastroentero Motil 2014; 26:654–659.CrossRefGoogle Scholar
  4. 4.
    Mittal RL. Motor function of the pharynx, esophagus and its sphincters. San Rafael (CA): Morgan & Claypoll Life Sciences; 2011.Google Scholar
  5. 5.
    Ayazi S, Crookes PF. High-resolution esophageal manometry: using technical advances for clinical advantages. J Gastrointest Surh 2010; 14 Suppl 1: S24-32.CrossRefGoogle Scholar
  6. 6.
    Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, Pandolfino JE, International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27:160–174.CrossRefPubMedGoogle Scholar
  7. 7.
    Dantas RO. Upper esophageal sphincter pressure in patients with Chagas’ disease and primary achalasia. Brazil J Med Biol Res 2000; 33:545–551.CrossRefGoogle Scholar
  8. 8.
    Yoneyama F, Miyachi M, Nimura Y. Manometric findings of the upper esophageal sphincter in esophageal achalasia. World J Surg 1998; 22:1043–1047.CrossRefPubMedGoogle Scholar
  9. 9.
    Dudnick RS, Castell JA, Castell DO. Abnormal upper esophageal sphincter function in achalasia. Am J Gastroenterol 1992; 87(12):1712–1715.PubMedGoogle Scholar
  10. 10.
    Ali GN, Hunt DR, Jorgensen JO, de Carle DJ, Cook IJ. Esophageal achalasia and coexistent upper esophageal sphincter relaxation disorder presenting with airway obstruction. Gastroenterology 1995; 109:1328–1332.CrossRefPubMedGoogle Scholar
  11. 11.
    Becker DJ, Castell DO. Acute airway obstruction in achalasia: possible role of defective belch reflex. Gastroenterology 1989; 97:1323–1326.PubMedGoogle Scholar
  12. 12.
    Chavez YH, Ciarleglio MM, Clarke JO, Nandwani M, Stein E, Roland BC. Upper esophageal sphincter abnormalities: Frequent finding on high-resolution esophageal manometry and association with poorer treatment response in achalasia. J Clin Gastroenterol 2015; 49:17–23.CrossRefPubMedGoogle Scholar
  13. 13.
    Jee SR, Pimentel M, Soffer E, Conklin JL. A high-resolution view of achalasia. J Clin Gastroenterol 2009; 43:644–651.CrossRefPubMedGoogle Scholar
  14. 14.
    Mathews SC, Ciarleglio M, Chavez YH, Clarke JO, Stein E, Roland BC. Upper esophageal sphincter abnormalities are strongly predictive of treatment response in patients with achalasia. World J Clin Cases 2014; 2:448–454.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Rezende DT, Herbella FAM, Silva LC, Panocchia Neto S, Patti MG. Upper esophageal sphincter resting pressure varies during esophageal manometry. Arq Bras Cir Dig 2014; 27:182–183.CrossRefPubMedGoogle Scholar
  16. 16.
    Tokashiki R, Funato N, Suzuki M. Globus sensation and increased upper esophageal sphincter pressure with distal esophageal acid perfusion. Eur Arch Otorhinolaryngol 2010; 267:737–741.CrossRefPubMedGoogle Scholar
  17. 17.
    Vicentine FP, Herbella FA, Allaix ME, Silva LC, Patti MG. High-resolution manometry classifications for idiopathic achalasia in patients with Chagas’ disease esophagopathy. J Gastrointest Surg. 2014 Feb;18(2):221–4; discussion 224–5. doi:  10.1007/s11605-013-2376-1. Epub 2013 Oct 16.
  18. 18.
    Wauters L, Van Oudenhove L, Selleslagh M, Vanuytsel T, Boeckxstaens G, Tack J, Omari T, Rommel N. Balloon dilation of the esophago-gastric junction affects lower and upper esophageal sphincter function in achalasia. Neurogastroenterol Motil 2014; 26:69–76.CrossRefPubMedGoogle Scholar
  19. 19.
    Takasaki K, Umeki H, Hara M, Kumagami H, Takahashi H. Influence of effortful swallow on pharyngeal pressure: evaluation using a high-resolution manometry. Otolaryngol Head Neck Surg 2011; 144:16–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Herbella FAM, Oliveira DRCF, Del Grande JC. Are idiophatic and chagasic achalasia two different disease. Dig Dis Scien 2004; 3:353–360.CrossRefGoogle Scholar
  21. 21.
    Vicentine FPP, Herbella FAM, Allaix ME, Silva LC, Patti MG. Comparison of idiopathic achalasia and Chagas’ disease esophagopathy at of high-resolution manometry. Dis Esophagus 2014; 27:128–133.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Mariano A. Menezes
    • 1
  • Fernando A. M. Herbella
    • 1
    • 3
  • Marco G. Patti
    • 2
  1. 1.Department of Surgery, Escola Paulista de MedicinaFederal University of São PauloSão PauloBrazil
  2. 2.Department of SurgeryUniversity of ChicagoChicagoUSA
  3. 3.Department of SurgeryEscola Paulista de MedicinaSao PauloBrazil

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