Abnormal neurophysiology in patients with oesophageal motility disorders

Background: The pathology of oesophageal motility disorders is poorly under stood. Oesophageal manometry provides only a descriptive assessment of lumi nal pressure changes. This study applied the investigative methods of the n europhysiologist to gain insight into the pathophysiology of these disorder s. Methods: Twelve healthy volunteers and 28 patients with oesophageal motilit y disorders underwent oesophageal manometry and balloon stimulation studies . Cortical evoked potentials (CEPs) in response to electrical stimulation o f the oesophagus and oesophageal motor evoked potentials (MEPs) to transcra nial magnetic stimulation of the cerebral cortex were recorded. Results: Only two patients had abnormalities with a primary defect in muscl e function. Fifteen had abnormal responses to balloon stimulation with norm al CEPs and MEPs, suggesting a defect in the intrinsic nerves of the oesoph agus. Five with achalasia did not respond to balloon stimulation and had ab normal CEPs and MEPs, suggesting widespread neural defects. The remainder h ad a variety of abnormal responses suggesting possible defects in receptor sensitivity, central processing or sensory neuropathy. There was no correla tion between the manometric diagnosis and abnormal neurophysiology, except in patients with achalasia. Conclusion: Neurophysiological testing suggests that oesophageal motility d isorders are most commonly due to a variety of neural defects.