Unclassified oesophageal motor disorders simulating achalasia.

Abstract

Achalasia of the oesophagus is characterized by the absence of peristalsis, failure of the inferior oesophageal sphincter to relax after swallowing (Harris, 1966), and a positive mecholyl test (Kramer and Ingelfinger, 1951).This combination offeatures is regarded as specific for this disease.Nevertheless, in the literature a number of cases have been designated achalasia despite the presence of some peristalsis or inferior sphincter relaxation (Vantrappen, van Goidsenhoven, Verbeke, van den Berghe, and Van- denbroucke, 1963) or even a negative mecholyl test (Hightower, Olsen, and Moersch, 1954).Therefore, absolute diagnostic criteria for the disease seem to be incompletely defined.We have studied six patients with severe oeso- phageal motor abnormalities referred to us with the clinical diagnosis of achalasia.The oesophageal motility findings in these patients were, however, not characteristic for achalasia; moreover, they were 'Presented in part to the American Gastroenterological Association, Colorado Springs, Colorado, on 26 May 1967.unlike any other recognized oesophageal motor disturbance.Because these patients clinically simulate achalasia but demonstrate some preservation of normal oesophageal motor function, it is possible that they represent variations of true achalasia. PATIENTSFive of the patients were males, one was a female.Ages ranged from 23 to 76 years.Standard barium oesophagrams in these patients showed the features of achalasia: oesophageal dilatation, barium retention, and distal oesophageal narrowing in all (Fig. 1).These radiographs and the presence of dysphagia had led to the clinical diagnosis of achalasia in each patient.CASE 1 N.D., a 38-year-old construction worker, initially noted difficulty in swallowing in 1962.One year later he experienced severe anterior chest pain associated with a 'catching sensation in the middle of the chest'.He was conservatively treated for 'obstruction of the oeso- phagus'.The return of substernal pain and progressive ND HH SS MP LJ EF 40M.69M.