Autonomic dysfunction in patients with achalasia of the oesophagus

Abstract

It has been suggested that achalasia is associated with extraoesophageal sympathetic and parasympathetic dysfunction. In a prospective study we applied conventional ultrasonography and duplex sonography to investigate basal and postprandial peak systolic velocity (PSV), pulsatility index (PI) and resistance index (RI) of superior mesenteric artery and PSV of portal vein in nine patients with achalasia and 10 healthy controls (study I). In addition, in eight of these patients autonomic nervous function was investigated by pupillary function tests as well as cardiovascular reflex tests and compared with eight age- and sex-matched controls (study II). The results indicated that postprandial increase of PSV in the superior mesenteric artery was significantly lower, and postprandial decrease of PI and RI significantly higher in achalasia compared to healthy controls. In contrast, postprandial increase of PSV in the portal vein was not significantly different between both groups. Autonomic function tests revealed significant lower maximal pupillary contraction and redilatation velocities, significantly lower heart rate variation during orthostasis, deep respiration test and Valsalva manoeuvre in achalasia compared to controls. It is concluded that achalasia is associated with extraoesophageal autonomic nervous dysfunction that involves cardiovascular and pupillary function as well as regulation of mesenteric arterial blood flow.

Achalasia and thyroid disease

“…A study has suggested that complement activation is involved in the autoimmune pathogenesis of achalasia [11] . Achalasia is associated with extra esophageal autonomic nervous dysfunction that involves cardiovascular and papillary function as well as regulation of mesenteric arterial blood flow [12] . Some investigators have proposed that achalasia may result from chronic infections with herpes zoster or measles viruses, but modern studies have not confirmed an association between achalasia and any recognized viral disease [13,14] .…”

What’s new in the pathology, pathophysiology and management of benign esophageal disorders?

“…An association with HLA epitopes has previously been reported and is investigated further by de la Concha et al 94 . A number of reports confirm that achalasia is not just a disease affecting the esophagus but can be linked to abnormalities in the cricopharyngeus, 95 stomach, 96 colon, 97 cardiovascular system, 98 and eye 99 . Several unusual complications have been reported, including cardiac compression 100 and tracheal obstruction 101 .…”

Absence of cardiovascular autonomic dysfunction and vagal pancreatic impairment in idiopathic achalasia of the oesophagus

“…The studies on extra‐oesophageal autonomic dysfunction in idiopathic achalasia reported contradictory results. The autonomic cardiovascular reflexes in patients with idiopathic achalasia are altered in some studies, 16–19 but in others they are normal 20–22 . Eckardt et al .…”

“…Von Herbay et al . observed statistical differences of parasympathetic tests between eight patients with achalasia and eight healthy volunteers, 17 but they also included patients with advanced age (until 81 years). The study of Ohlsson et al 19 .…”