Abstract
Eleven of 381 patients who underwent diagnostic esophageal-motility tests were found to have a "hypercontracting sphincter" characterized by prolonged and powerful contractions of the gastroesophageal sphincter. Other motility disturbances included esophageal motor incoordination, diffuse spasm of the esophagus in two patients, and pressure changes of hiatal hernia, which were present in six patients. Substernal pain, occasionally thought to be of cardiac origin, and dysphagia were prominent complaints in nine of the patients, while two patients had no gastrointestinal-tract symptoms. Reassurance, symptomatic treatment, and medical management of hiatal hernia were generally effective, but because of incapacitating pain in two patients, esophagomyotomy was performed and provided excellent relief of symptoms. A hypercontracting gastroesophageal sphincter should be considered in patients with unexplained chest pain, since the diagnosis, made only by manometry, will allow appropriate and effective treatment.
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