HIGH AMPLITUDE CONTRACTIONS IN THE MIDDLE 1 3 OF THE ESOPHAGUS - A MANOMETRIC MARKER OF CHRONIC-ALCOHOLISM/

Background-Oesophageal motor abnormalities have been reported in alcoh olism. Aim-To investigate the effects of chronic alcoholism and its wi thdrawal on oesophageal disease. Patients-23 chronic alcoholic patient s (20 men and three women; mean age 43, range 23 to 54). Methods-Endos copy, manometry, and 24 hour pH monitoring 7-10 days and six months af ter ethanol withdrawal. Tests for autonomic and peripheral neuropathy were also performed. Motility and pH tracings were compared with those of age and sex matched control groups: healthy volunteers, nutcracker oesophagus, and gastro-oesophageal reflux disease. Results-14 (61%) a lcoholic patients had reflux symptoms, and endoscopy with biopsy showe d oesophageal inflammation in 10 patients. One patient had an asymptom atic squamous cell carcinoma. Oesophageal motility studies in the alco holic patients showed that peristaltic amplitude in the middle third w as >150 mm Hg (95th percentile (P95) of healthy controls) in 13 (57%), the ratio lower/ middle amplitude was <0.9 in 15 (65%) (>0.9 in all c ontrol groups), and the lower oesophageal sphincter was hypertensive ( >23.4 mm Hg, P95 of healthy controls) in 13 (57%). All three abnormali ties were present in five (22%). Abnormal reflux (per cent reflux time >2.9, P95 of healthy controls) was shown in 12 (52%) alcoholic patien ts, and was unrelated to peristaltic dysfunction. Subclinical neuropat hy in 10 patients did not effect oesophageal abnormalities. Oesophagea l motility abnormalities persisted at six months in six patients with ongoing alcoholism, whereas they reverted towards normal in 13 who rem ained abstinent; reflux, however, was unaffected. Conclusions-Oesophag eal peristaltic dysfunction and reflux are frequent in alcoholism. Hig h amplitude contractions in the middle third of the oesophagus seem to be a marker of excessive alcohol consumption, and tend to improve wit h abstinence.