AUTONOMIC DYSFUNCTION IN PATIENTS WITH ACHALASIA

It has been previously shown that patients with achalasia may have mot or abnormalities of the stomach, small bowel and biliary system. This study investigates whether a disturbance of extraintestinal autonomic function occurs. Autonomic function studies were performed in 15 patie nts with achalasia and 15 age- and sex-matched healthy controls. Pupil lograms were obtained during darkness, light exposure and after piloca rpine administration. Cardiovascular function studies included determi nations of heart rate variation during deep breathing and orthostasis. In addition, we determined blood pressure changes in response to sust ained handgrip, cold exposure and orthostasis. Neurohormonal function was investigated by measuring serum pancreatic polypeptide (PP) levels prior to and following sham feeding. Pupillary function did not diffe r in patients as compared with controls. However, 9 of 15 patients (95 % CI: 32-84%) and none of the controls showed at least one abnormal au tonomic cardiovascular response. A significant difference between the two groups was observed in sympathetic function (P = 0.023). More pati ents than controls did not respond to sham feeding with a PP increase. It is concluded that some patients with achalasia exhibit an abnormal ity of the autonomic nervous system that extends beyond the gastrointe stinal tract. These abnormalities mainly concern cardiovascular functi on but may also involve neurohormonal responses.