Achalasia: a vagal disease

Achalasia is considered to be a primary motor disorder of the oesophagus. However, there is increasing evidence to suggest extra-oesophageal involvement in this disease. Vagal disturbances at different levels and extra-oesophageal dysmotility have been reported in several studies. The aim of this study was to examine cardiovascular reflexes in patients with achalasia further to evaluate the involvement of the autonomic nervous system outside the oesophagus in this entity.

Five patients (age range 38-58 years, median 45 years) diagnosed with achalasia were assessed for the autonomic nerve function by the heart rate reaction to deep breathing (E/I ratio) and to tilt (acceleration and brake index). The blood pressure reaction to tilt was also assessed. The results were compared with a control group comprising 56 healthy individuals (age range 16-59 years, median 40 years).

Patients with achalasia had a significantly decreased E/I ratio compared with controls (absolute values 1.13 (0.23) (median value (interquartile range)) versus 1.38 (0.14): P=0.0309, age corrected values -1.39 (1.49) versus -0.25 (1.20): P=0.0457). This reflects impairment of the vagus nerve. In contrast, sympathetic nerves were not affected, as the acceleration index and brake index and postural blood pressure reaction were not disturbed in patients.

Patients with achalasia have autonomic nerve dysfunction in the vagal nerve outside the oesophagus.