Anomalies of peristalsis in idiopathic diffuse oesophageal spasm

Oesophageal manometry revealed 'interrupted peristalsis'--proximal sequential contraction with simultaneous pressure increases in the mid-oesophagus and sequential contraction distally--and abnormally slow distal propagation of peristalsis in seven of a consecutive series of 12 patients with idiopathic diffuse oesophageal spasm (IDOS). These two abnormalities occurred together in six patients. It is proposed that 'interruption' of peristalsis and 'slow' distal propagation are apparent rather than real, and that they reflect failure of normal luminal obliteration during oesophageal contraction. This arguments is extended to the 'aperistalsis' of achalasia. It is also proposed that IDOS, achalasia, and related idiopathic motor disorders may share a common pathogenetic abnormality--namely, functional obstruction at the level of the lower oesophageal sphincter. According to this hypothesis, the presentation of the patient and the progression of his disease are determined by the degree and duration of that obstruction, and the functional reserve of the oesophageal body musculature.