Radiologic and manometric study of the gastroesophageal junction in dysphagia aortica

This article reports radiologic and manometric findings in dysphagia aortica, with particular attention to the gastroesophageal (GE) junction. Records of three patients, ages 70-78 years, with clinical/radiologic dysphagia aortica were compared to those in control groups. Subsequently, manometric findings of such vascular compression were sought in 10 consecutive patients > or = 65 years old with dysphagia. The three patients with dysphagia aortica had radiologic/endoscopic evidence for compression at the GE junction. Manometric studies, performed in two of them, showed evidence at the GE junction for superimposed rhythmic contractions at 60-72/min (maximum amplitudes, 35 mm Hg), consistent with vascular compression. One patient had marked elevation of "sphincter" pressure to 110 mm Hg and "poor relaxation" of the "sphincter." One of 10 patients with dysphagia had rhythmic contractions of 20 mm Hg; a barium study subsequently showed aortic compression at the GE junction. There are characteristic manometric findings that may help to identify symptomatic vascular compression of the esophagus in the elderly.