Prolonged manometric recordings of oesophagus and lower oesophageal sphincter in achalasia patients

Background and aims-Conventional. short term manometry is a valuable tool i n the diagnosis of achalasia but the technique may fail to detect intermitt ent motor events. The aim of this study was to investigate the pattern of l ower oesophageal sphincter (LOS) and oesophageal pressures during prolonged recording in patients with achalasia. Methods-Eleven patients with idiopathic achalasia were studied. Prolonged c ombined oesophageal. pH and manometric recordings of the pharynx, LOS, and stomach were performed using a pH glass electrode and a multiple lumen asse mbly incorporating a Dent sleeve connected to a portable water perfused man ometric system. Results-LOS pressure varied during the day. Postprandial LOS pressures were lower than those recorded preprandially (1.2 v 1.8 kPa; p=0.005) and basal LOS pressures were significantly higher during phase III of the migrating motor complex than during the subsequent phase I (3.3 v 1.8 kPa; p=0.028). Complete LOS relaxations were occasionally observed in seven patients (0.48 /h). Complete LOS relaxations were longer in duration than incomplete LOS r elaxations (10.8 v 2.8 s; p=0.01) and 57% of complete relaxations fulfilled the criteria of a transient LOS relaxation (TLOSR). Complete LOS relaxatio ns were associated with oesophageal pressure waves with higher amplitudes a nd longer durations. In addition, a higher proportion of these oesophageal pressure waves were spontaneous (55.6% v 0%; p <0.02) and multipeaked (72.7 % v 0%). During prolonged manometry, high amplitude oesophageal pressure wa ves (> 10 kPa) were recorded in six patients and retrograde oesophageal pre ssure waves in four, phenomena which were not observed during short term ma nometry. Conclusion-In contrast with short term stationary manometry, prolonged mano metry in achalasia patients revealed the occurrence of complete LOS relaxat ions, TLOSRs, variations in LOS pressure associated with a meal or phase II I, and high amplitude and retrograde oesophageal pressure waves.