INCOMPLETE UPPER ESOPHAGEAL SPHINCTER RELAXATION - ASSOCIATION WITH ACHALASIA BUT NOT OTHER ESOPHAGEAL MOTILITY DISORDERS

Incomplete upper esophageal sphincter (UES) relaxation is not well und erstood. We compared clinical and manometric characteristics of patien ts with normal and abnormal UES relaxation. Consecutive patients (n = 208) underwent manometric evaluation of the lower esophageal sphincter (LES), esophageal body, and UES/pharynx. The patients were divided in to those with abnormal UES relaxation (residual pressure > 6.7 mmHg) ( n = 21) and normal relaxation (n = 187). Clinical and manometric profi les were compared. Sex, age, and presenting complaint did not correlat e with UES relaxation. Normal esophageal peristaltic sequences were mo re frequently present in the normal UES group (73.6%) compared with th e abnormal (55.8%) (p < 0.01). The UES relaxation was shorter in the g roup with abnormal relaxation (410.0 ms vs. 510.2 ms, p < 0.001). All other manometric parameters were not different between the two groups. When individual manometric diagnoses were analyzed, only achalasia wa s noted to be more common in the abnormal UES group (23.8% vs. 9.1%, p < 0.05), and a trend was noted toward diffuse esophageal spasm being more common (14.3% vs. 9.6%, not significant). We conclude that incomp lete UES relaxation is a rare manometric finding, associated with acha lasia and not specifically associated with any other motility disturba nce. This finding may represent a secondary response to the poor esoph ageal emptying seen in achalasia.