ESOPHAGEAL AND ANORECTAL MOTILITY IN PATI ENTS WITH SPHINCTER OF ODDIDYSFUNCTION

Esophageal and anorectal motility have not been systematically evaluat ed in patients with sphincter of Oddi dysfunction (SOD). We have inves tigated 8 consecutive patients (6 females, 52.5 +/- 9.5 y) with type I -SOD (according to the Milwaukee-classification), 12 patients (9 femal es, 50.4 +/- 12.3 y) with type III-SOD, and 20 healthy volunteers (15 females, 48.5 +/- 15.2 y) by means of a standardized questionnaire for esophageal and anorectal symptoms, esophageal manometry, colonic tran sit time evaluation, and anorectal manometry. Symptom-scores did not d iffer significantly between type-I and type ill-SOD-patients, respecti vely. Furthermore, there were no relevant differences of the symptom-s cores of the SOD-patients vs. healthy subjects. However, the lower eso phageal sphincter pressure (LESP) was significantly higher in patients with type I-SOD (26.8 +/- 7.4 mmHg) than in both, type Ill-SOD-patien ts (20.3 +/- 4.0 mmHg, p < 0.05) and healthy subjects (18.6 +/- 3.5 mm Hg, p < 0.001), respectively. Mean colonic transit time did not differ significantly between both groups of patients (type I-SOD, 27.9 +/- 2 1.4 h, vs, type III-SOD, 28.5 +/- 15.1 h, p < 0.05). The anal sphincte r resting pressure (ARP) was significantly higher in patients with typ e I-SOD (90.8 +/- 15.5 mmHg) than in healthy subjects (74.1 +/- 10.3, p < 0.01), but did not differ significantly from that in patients with type III-SOD (82.1 +/- 11.5 mmHg, p = 0.17). Computer-assissted ''bea t-to-beat''-evaluation showed an abnormal heart rate variability in 3/ 8 patients with type I-SOD. These results give evidence for a systemic involvement of the lower esophageal and the anal sphincter in patient s with type I-SOD, which does not occur in patients with type III-SOD.