Cardiovascular Autonomic Deficits in Different Types of Achalasia

Area of Science:

• Gastroenterology
• Neurology
• Cardiology

Background:

• Achalasia cardia is a primary esophageal motility disorder with unknown progression.
• Autonomic dysfunction has not been extensively studied across different achalasia types.

Purpose of the Study:

• To investigate autonomic dysfunction in various types of achalasia.
• To compare autonomic function in achalasia patients with healthy controls.

Main Methods:

• Diagnosis of achalasia using high-resolution esophageal manometry (HRM) based on Chicago classification v4.0.
• Performance of autonomic function tests (AFT) including head-up tilt test, deep breathing test (DBT), Valsalva maneuver (VM), handgrip test (HGT), cold pressor test (CPT), and heart rate variability (HRV) test.
• Comparison of test results between 62 achalasia patients (types I, II, III) and 39 healthy controls.

Main Results:

• All achalasia types exhibited a generalized loss of parasympathetic and baroreflex-independent sympathetic reactivity.
• Baroreflex-dependent cardiovascular adrenergic reactivity remained normal.
• Cardiac autonomic tone showed reduced parasympathetic and sympathetic influence, though sympathovagal balance was maintained.
• Autonomic dysfunction severity was higher in type I, followed by type II achalasia.

Conclusions:

• Achalasia patients demonstrate decreased parasympathetic reactivity, baroreflex-independent sympathetic reactivity, and cardiac autonomic tone compared to controls.
• The severity of autonomic dysfunction correlates with disease progression, being more pronounced in type I than type II achalasia.