The critical cysteine in the gastric H, K ATPase for inhibition of acid secretion by proton pump inhibitors

Abstract

The main advantage of endoscopic ultrasonogmphy for study of motor disorders of the esophagus is the ability to detect small tumors that can cause pseudoachalasia. Histological evidence of thickening of the muscle layer and ultmsonographie images of thickening of the hypoechogenic 4th layer ( corresponding to the muscle layer) has been inconsistently reported in patients with idiopathic achalasia. The purpose of this study was to assess the morphology and thickness of the lower esophagus wall by endoscopic ultrasonography in patients presenting idiopathic achalasia and to correlate findings with manometric data (lower esophageal sphincter (LOS) pressure). Patients and methods : Twelve patients (8 men, 4 women) with a mean age of 51 years (27 to 75 years) underwent endoscopic ultrasonography (Eehogastroscope Olympus, model EUM3) prior to treatment of achalasia diagnosed by manometry, barium swallow, and esophagoscopy. The wall of the lower esophagus was examined and measured 3 cm above the cardia at a frequency of 12 MHz. Results were compared to similar data obtained in a control group of 12 patients without esophageal disease, in whom endoscopy of the upper digestive tract and manometry were normal. Restilts : The structure of the esophageal wall was normal in the 14 patients with achalasia. The mean thickness of the wall of the lower esophagus was not significantly different in patients with achalasia and controls (3.0 + 0.1 mm versus 2.9 ± 0.1 mm). In patients with achalasia, manometry showed LOS pressure to be elevated in 8 cases and normal in 4 cases. There was no correlation between the thickness of the esophageal wall determined by endoscopic ultrasonography and LOS pressure determined by manometry. Conclusion : Significant thickening of the wall of the lower esophagus cannot be demonstrated by endoscopic ultrasonography in patients presenting idiopathic achalasia, regardless of thepressure of the LOS. ~THE CRITICAL CYSTEINE IN THE GASTRIC H,K ATPase FOR INHIBITION OF ACID SECRETION BY PROTON PUMP INHIBITORS.