Studies of autonomic function in patients with achalasia and nutcracker oesophagus

Background Post-mortem studies in patients with achalasia reveal degenerati ve changes in the vagus and its dorsal motor nuclei suggesting the possibil ity of widespread autonomic dysfunction. Aims To study a broad range of autonomic function in patients with achalasi a and nutcracker oesophagus and in asymptomatic volunteers. Subjects Patients with a manometric diagnosis of achalasia and nutcracker o esophagus and age- and sex-matched asymptomatic volunteers. Methods Subjects underwent measurement of: (1) pupil cycle time estimation; (2) heart rate response to the Valsalva manoeuvre, standing and deep breat hing; (3) systolic blood pressure response to standing; (4) diastolic respo nse to sustained handgrip; (5) spectral analysis of heart rate variability; and (6) heart rate and blood pressure during the Valsalva manoeuvre. Results No significant differences were found between patients with achalas ia and asymptomatic volunteers. Patients with nutcracker oesophagus, howeve r, had longer pupil cycle times (1.2 (0.9-1.4) s versus 0.9 (0.8-1.2) s, P = 0.02) and had attenuation of both the rise in the low frequency peak of h eart rate variability and the fall in the high frequency peak on standing ( rise in low frequency peak - patients 26.6 (10.4-52.3)% to 42.2 (15.5-54.0) %, P = 0.46, volunteers 16.9 (8.4-37.2)% to 47.4 (21.1-66.3)%, P = 0.03; fa ll in high frequency peak - patients 18.1 (0.9-43.3)% to 10.1 (0.5-26.6)%, P = 0.46, volunteers 24.8 (8.5-44.4)% to 9.3 (2.6-35.6)%, P = 0.03). The ri se in blood pressure during the Valsalva manoeuvre was also attenuated in p atients with nutcracker oesophagus compared with asymptomatic volunteers (6 .9 (1.0-9.3) mmHg versus 12.9 (11-23.0) mmHg, P< 0.01). Conclusions Whereas tests of cardiovascular and pupillary autonomic functio n are normal in patients with achalasia, patients with nutcracker oesophagu s show defects in both parasympathetic and sympathetic function. fur I Gast roenterol Hepatol 11:1349-1354 (C) 1999 Lippincott Williams & Wilkins.