A new method for the detection of incomplete lower esophageal sphincter relaxation in patients with achalasia

Background: In patients with early stages of achalasia manometry is of sign ificant diagnostic value. Technically, however, measurement of lower esopha geal sphincter (LES) relaxation is not always easy. Accordingly, we looked for a simpler way of measuring incomplete LES relaxation. Methods: In 186 c onsecutive patients referred to esophageal motility testing the esophageal body base-line pressure was measured during continuous swilling of 180 ml f luid within 20 sec. Results:Seventeen of the 186 patients had achalasia. Fo urteen of these patients were compliant for the swill test, and all had a p ositive test, characterized by a steady increase in base-line pressure with negative deflections on deglutition. All non-achalasia patients could comp lete the test, which was negative in all except one patient, who had a seve re peptic stricture. Conclusions: The swill test is diagnostic for incomple te lower esophageal relaxation in achalasia in compliant patients without o rganic stenosis.