Esophageal manometry and radionuclide emptying in chronic alcoholics

Eighteen asymptomatic alcoholics, half with neuropathy, were studied within 3 days of drinking to evaluate the frequency, nature, and underlying causes of esophageal dysmotility. Ten were restudied after a month of sobriety. The mean lower esophageal sphincter pressure and esophageal contraction amplitude in alcoholics were significantly higher than controls. Radionuclide esophageal emptying was slower than controls. Abnormal motility studies included 9 patients with nutcracker esophagus and 5 patients with nonspecific motor disorder. After 1 mo of abstinence, 5 of 6 patients with nutcracker esophagus and one with nonspecific motor disorder became normal. Lower esophageal sphincter pressure and esophageal contraction amplitude also returned to normal. These abnormal findings were independent of neuropathy. One patient who had normal manometry and emptying had esophagitis. We demonstrated that esophageal dysfunction is common in alcoholics, even in the absence of esophagitis and neuropathy, suggesting that these do not play a major role in esophageal dysmotility. Nutcracker esophagus is a reversible and common manometric finding in asymptomatic alcoholics.