Rhythmic spontaneous contractions in patients with esophageal symptoms

Eight patients were identified over a 4-yr period with rhythmic spontaneous contractions of the esophagus. The contraction waves were found to originate immediately below the region of the upper esophageal sphincter in all patients, and propagated a short distance into the proximal esophagus. Mean interval between waves varied from 3.8 to 7.2 s, and all described patients had sequences of at least 5 repetitive waves. Contraction sequences were often initiated and terminated by swallows, but at other times occurred and ceased independent of swallows. Long periods of esophageal baseline pressure elevation were observed in the distal esophageal body, an indicator of poor esophageal clearance presumably related to the rhythmic contraction sequences. Half of the patients had endoscopic or radiographic evidence of reflux-related esophageal injury, yet dysphagia was the most commonly reported symptom. Concomitant manometric abnormalities of the esophageal body may have contributed to symptom production in several of the patients. This rare finding occurring singularly or in combination with other disorders may represent a symptomatic motility derangement that can be detected by systematic sampling of the entire esophagus during manometric examination.