THE RELEVANCE OF ABNORMAL MOTILITY PATTERNS IN INTRA-MURAL ESOPHAGEALLEIOMYOMATA

Objective. Abnormal oesophageal motility patterns of the obstructive t ype in patients with gastro-oesophageal reflux without clinical eviden ce of obstruction raise the possibility of some co-existing problem. M ethods. In order to elucidate the relevance of such motility we studie d two patients who were diagnosed as manifesting gastro-oesophageal re flux without herniation on full oesophageal investigations including r adiology, ambulatory pH metry and endoscopy. In both patients leiomyom ata were enucleated from the gastro-oesophageal junction at the time o f surgery for reflux and subsequent oesophageal motility studies showe d a return to near normal patterns. We studied, in retrospect, the mot ility patterns of two other patients with dysphagia due to a leiomyoma in the middle and upper oesophagus, respectively, and in whom the dia gnosis of an oesophageal leiomyoma was made on clinical and radiologic al criteria. One of these patients was also studied post-operatively. Results. A detailed study of these motility patterns shows exaggerated oesophageal contractions without features specific to achalasia cardi a or localised oesophageal spasm, and that these features are reversed by surgical enucleation of the tumour. Conclusions. In these four pat ients the abnormal motilities are attributable to the presence of the intramural tumours despite the absence of clinical evidence of obstruc tion.