Cardiovascular autonomic function in patients with primary achalasia

Impaired gastrointestinal function outside the esophagus has been found in achalasic patients. Moreover, achalasia may occur in diseases in which a sy stemic dysautonomia is evident. These findings raise the question of whethe r a generalized subclinical alteration of autonomic control is also present in primary achalasia. Cardiovascular reflex tests and power spectral analy sis of heart rate variability were studied in patients with primary achalas ia to establish whether autonomic nervous system changes are present in dis tricts other than the gastrointestinal tract. Nineteen normotensive patient s with untreated primary achalasia and with no history of cardiac, renal, o r endocrinological diseases were examined. Cardiovascular reflex tests incl uded: the tilt test (10 min at 65 degrees), Valsalva maneuver (40 mm Hg for 15 sec), deep breathing (6 breaths/min), and sustained handgrip (30% of ma ximal effort for 5 min). The parameters evaluated were systolic and diastol ic blood pressure (continuously recorded), EGG, oronasal and thoracic respi ration, tachogram, and plethysmogram. To evaluate the balance between paras ympathetic and sympathetic functions, power spectral analysis of the heart rate variability was carried out. Each patient was paired with two sex- and age-matched healthy controls. In achalasic patients the head-up tilt test, Valsalva maneuver, deep breathing test, and sustained handgrip did not sho w significant differences from the control group. Low-frequency (LF) and hi gh-frequency (HF) spectral powers and the ratio of LF to HF did not differ in both groups. This study failed to disclose impaired cardiovascular auton omic control in achalasic patients. We suggest that in primary achalasia th e defect is limited to the gastrointestinal tract.