The relevance of abnormal motility patterns in intra-mural oesophageal leiomyomata

Abnormal oesophageal motility patterns of the obstructive type in patients with gastro-oesophageal reflux without clinical evidence of obstruction raise the possibility of some co-existing problem.

In order to elucidate the relevance of such motility we studied two patients who were diagnosed as manifesting gastro-oesophageal reflux without herniation on full oesophageal investigations including radiology, ambulatory pH metry and endoscopy. In both patients leiomyomata were enucleated from the gastro-oesophageal junction at the time of surgery for reflux and subsequent oesophageal motility studies showed a return to near normal patterns. We studied, in retrospect, the motility patterns of two other patients with dysphagia due to a leiomyoma in the middle and upper oesophagus, respectively, and in whom the diagnosis of an oesophageal leiomyoma was made on clinical and radiological criteria. One of these patients was also studied post-operatively.

A detailed study of these motility patterns shows exaggerated oesophageal contractions without features specific to achalasia cardia or localised oesophageal spasm, and that these features are reversed by surgical enucleation of the tumour.

In these four patients the abnormal motilities are attributable to the presence of the intramural tumours despite the absence of clinical evidence of obstruction.