Achalasia: The Length of the Esophagus and the Response to Treatment

Abstract

Achalasia of the esophagus is a disease of unknown etiology, characterized by increased esophageal outflow resistance and absent body peristalsis. These two factors gradually lead to a progressive decompensation in function and a progressive increase in diameter. Whether the increase in diameter is related to functional decompensation or outflow, obstruction is conjectural. The decompensation is manifest clinically by increasing dysphagia and regurgitation, radiologically by an increase in the diameter and tortuosity of the esophagus, and manometrically by a decrease in swallow response amplitude. The lower esophageal sphincter pressure is increased in some achalasic patients, and whether the high pressure is related to simultaneous increases in length and diameter of the esophagus as well as a decrease in function is also not established. We measured the esophageal length in normal adults and achalasic patients manometrically, and correlated the results with the patients height. The aim was to determine if esophageal length could be used as a measure of esophageal decompensation. In a separate group, we assessed the changes in length following pneumatic dilatation or surgical myotomy.