Gastrointestinal symptoms of patients with esophageal contraction abnormalities

Nonesophageal, gastrointestinal symptoms were sought from consecutive patients referred for esophageal manometry in order to determine the prevalence of such symptoms in relation to manometric diagnosis. Reports by 103 patients with esophageal contraction abnormalities, a cluster of manometric findings which includes the "nutcracker esophagus" and diffuse esophageal spasm, were compared to those by patients with the achalasia pattern (21 patients) and scleroderma esophagus (19 patients). A history of persistent (greater than 3 months) bowel habit abnormality requiring medical attention was reported by 19% of those with contraction abnormalities and 26% of those with scleroderma esophagus but by no patient with achalasia (P less than 0.05 for both compared to achalasia). Patients with contraction abnormalities had complained to physicians of more gastrointestinal symptoms and had more often been diagnosed as having the irritable bowel syndrome than those with achalasia. We conclude that, with regard to gastrointestinal symptoms, patients with esophageal contraction abnormalities more closely resemble patients with a motility disorder which has the potential for diffuse symptomatic gastrointestinal involvement (scleroderma) than those with a motility disorder restricted to the esophagus (achalasia). These findings add support to the argument that functional gastrointestinal syndromes may be representative of diffuse neuromuscular derangement in the gastrointestinal tract.