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Achalasia: a vagal disease
B Ohlsson1, O Ekberg, G Sundkvist
1Dept. of Medicine, Malmö University Hospital, Sweden. bodil.ohlsson@kir.lu.se
Scandinavian Journal of Gastroenterology
|June 30, 2004
Summary
Patients with achalasia exhibit vagal nerve dysfunction outside the esophagus. This study found impaired heart rate responses to breathing and tilt, indicating autonomic nervous system involvement beyond the esophagus.
Area of Science:
- Gastroenterology
- Neurology
- Cardiology
Background:
- Achalasia is primarily viewed as an esophageal motility disorder.
- Emerging evidence suggests broader involvement of the autonomic nervous system.
- Extra-esophageal dysmotility and vagal disturbances are increasingly reported in achalasia patients.
Purpose of the Study:
- To investigate cardiovascular reflexes in achalasia patients.
- To further evaluate autonomic nervous system involvement outside the esophagus.
- To assess vagal nerve function in achalasia.
Main Methods:
- Assessed autonomic nerve function in 5 achalasia patients (ages 38-58).
- Measured heart rate response to deep breathing (E/I ratio) and tilt (acceleration and brake indices).
- Compared results with 56 healthy controls.
Main Results:
- Achalasia patients showed a significantly decreased E/I ratio, indicating vagal nerve impairment (P=0.0309).
- Cardiovascular reflexes related to sympathetic nerve function (acceleration/brake indices, blood pressure response to tilt) were not significantly affected.
- Results suggest specific autonomic dysfunction in the vagal nerve.
Conclusions:
- Achalasia patients experience autonomic nerve dysfunction affecting the vagal nerve.
- This dysfunction extends beyond the esophagus.
- Findings highlight the systemic neurological impact of achalasia.