Abstract
The positive methacholine response of the esophagus in patients with achalasia was studied by comparing simultaneous measurements obtained by balloon kymography and intraluminal esophageal manometry. Prior to this, mechanical characteristics of the balloonkymograph system were assessed, in particular the response of the system to external pressure on the balloon. The balloon-kymograph system has a nonlinear response. Little change in balloon volume occurs until external pressure reaches approximately 15 mm Hg. Thereafter, rapid emptying of the balloon occurs over the next 5 to 10 mm Hg and the balloon is totally collapsed at approximately 25 mm Hg or its water equivalent, 34 cm. External pressures above this level cannot be appreciated by the collapsed balloon. These features were demonstrated in 6 patients with achalasia. It is suggested that a positive response to methacholine may be defined as a rise in esophageal intraluminal pressure to greater than 25 mm of mercury or its water equivalent. Accurate definition of esophageal sensitivity to methacholine and its usefulness as a diagnostic tool must await more quantitative studies.
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