Manometric abnormalities of the oesophagus in patients with Parkinson's disease

Dysphagia in Parkinson's disease (PD) is known to correlate, with abnormali ties of oropharyngeal function. Oesophageal abnormalities have not been pre viously demonstrated to correlate with dysphagia. The aim of the study was to determine if motor dysfunction of the oesophageal body correlates with d ysphagia or disease severity in PD. Twenty-two patients with PD were assess ed for the severity of their dysphagia (scale. of 1-7) and severity of PD ( Hoehn and Yahr scale 1-4). All underwent oesophageal manometry. Dysphagia w as present daily in 10 patients (45%). Parkinson's disease was graded as se vere (Hoehn and Yahr >=3) in eight (36%) patients. Oesophageal manometry wa s abnormal in 16 (73%) patients. Thirteen patients had either complete aper istalsis or multiple simultaneous contractions (diffuse oesophageal spasm). These findings were significantly more common in patients with daily dysph agia (90% vs. 33%; P < 0.005), and were not related to duration or severity of PD. We conclude that the presence of aperistalsis or multiple simultane ous contractions in the oesophagus does correlate with dysphagia and is ind ependent of PD severity or duration. This may reflect selective involvement of either the dorsal motor nucleus of the vagus or the oesophageal myenter ic plexus.