Prevalence of Increased Esophageal Muscle Thickness in Patients With Esophageal Symptoms

BACKGROUND:Patients with achalasia, diffuse esophageal spasm (DES), and nutcracker esophagus have a thicker muscularis propria than normal subjects. The goal of our study was to determine the prevalence of increased muscle thickness in a group of unselected patients referred to the esophageal function laboratory for evaluation of the symptoms.METHODS:We studied 40 normal subjects and 94 consecutive patients. Manometry and ultrasound images were recorded concurrently, using a special custom-built catheter. Esophageal muscle thickness and muscle cross-sectional area were measured at 2 and 10 cm above the lower esophageal sphincter (LES). Patients were assigned manometric diagnosis and determination was made if they had increased muscle thickness and muscle cross-sectional area.RESULTS:Nearly all patients with well-defined spastic motor disorders, i.e., achalasia, DES, and nutcracker esophagus, revealed (a) an increase in the muscle thickness/cross-sectional area, (b) increase in esophageal muscle thickness/cross-sectional area was also seen, albeit at a lower prevalence rate, in patients with less well-characterized manometric abnormalities, i.e., hypertensive LES, impaired LES relaxation, and ineffective esophageal motility, and (c) 24% of patients with esophageal symptoms but normal manometry were also found to have an increase in muscle thickness/cross-sectional area. Dysphagia was more likely, and heartburn less likely in patients with increased muscle thickness, but there were no differences in chest pain and regurgitation symptoms between the groups.CONCLUSION:We describe, for the first time, increased muscle thickness in patients with esophageal symptoms and normal manometry. We suggest that increased esophageal muscle thickness is likely to be an important marker of esophageal motor dysfunction.

[1]  J. Liu,et al.  Oesophageal wall stress and muscle hypertrophy in high amplitude oesophageal contractions § , 2005, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[2]  V. Bhargava,et al.  Sensory and motor function of the esophagus: lessons from ultrasound imaging. , 2005, Gastroenterology.

[3]  E. Ebert,et al.  Pneumatic dilatation in patients with symptomatic diffuse esophageal spasm and lower esophageal sphincter dysfunction , 1983, Digestive Diseases and Sciences.

[4]  R. Mittal,et al.  Oesophageal motor functions and its disorders , 2004, Gut.

[5]  R. Mittal,et al.  Hypertrophy of the muscularis propria of the lower esophageal sphincter and the body of the esophagus in patients with primary motility disorders of the esophagus , 2003, American Journal of Gastroenterology.

[6]  R. Mittal,et al.  Relationship between esophageal muscle thickness and intraluminal pressure in patients with esophageal spasm. , 2002, American journal of physiology. Gastrointestinal and liver physiology.

[7]  K. Chayama,et al.  Evaluation of Esophageal Motility by Endosonography Using a Miniature Ultrasonographic Probe in Patients with Reflux Esophagitis , 2002, Scandinavian journal of gastroenterology.

[8]  S. Ward,et al.  Loss of interstitial cells of Cajal and development of electrical dysfunction in murine small bowel obstruction , 2001, The Journal of physiology.

[9]  J. Brasseur,et al.  Local longitudinal muscle shortening of the human esophagus from high-frequency ultrasonography. , 2001, American journal of physiology. Gastrointestinal and liver physiology.

[10]  H. Mashimo,et al.  Lower Esophageal Sphincter Is Achalasic in nNOS−/− and Hypotensive in W/Wv Mutant Mice , 2001 .

[11]  S. Spechler,et al.  Classification of oesophageal motility abnormalities , 2001, Gut.

[12]  P. Kahrilas,et al.  Manometric heterogeneity in patients with idiopathic achalasia. , 2001, Gastroenterology.

[13]  H. Mashimo,et al.  Lower esophageal sphincter is achalasic in nNOS(-/-) and hypotensive in W/W(v) mutant mice. , 2001, Gastroenterology.

[14]  J. Malagelada,et al.  Complete lower esophageal sphincter relaxation observed in some achalasia patients is functionally inadequate. , 2000, American journal of physiology. Gastrointestinal and liver physiology.

[15]  D. Castell,et al.  Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms , 1999, American Journal of Gastroenterology.

[16]  R. Jacob,et al.  The functional significance of ventricular geometry for the transition from hypertrophy to cardiac failure. Does a critical degree of structural dilatation exist? , 1998, Basic Research in Cardiology.

[17]  E. Melzer,et al.  Assessment of the esophageal wall by endoscopic ultrasonography in patients with nutcracker esophagus. , 1997, Gastrointestinal endoscopy.

[18]  H. Gregersen,et al.  Unexplained Chest Pain: The Hypersensitive, Hyperreactive, and Poorly Compliant Esophagus , 1996, Annals of Internal Medicine.

[19]  W. Domschke,et al.  Diffuse esophageal spasm: a malfunction that involves nitric oxide? , 1995, Scandinavian journal of gastroenterology.

[20]  B. Goldberg,et al.  Correlation of high-frequency esophageal ultrasonography and manometry in the study of esophageal motility. , 1995, Gastroenterology.

[21]  J. Behar,et al.  Pathogenesis of simultaneous esophageal contractions in patients with motility disorders. , 1993, Gastroenterology.

[22]  M. Fujino,et al.  Nonspecific esophageal motor disorder associated with thickened muscularis propria of the esophagus. , 1992, Gastroenterology.

[23]  K. Schulze-Delrieu,et al.  Hypertrophic smooth muscle in the partially obstructed opossum esophagus. The model: histological and ultrastructural observations. , 1991 .

[24]  R. Mittal,et al.  Modulation of feline esophageal contractions by bolus volume and outflow obstruction. , 1990, The American journal of physiology.

[25]  R. McCallum,et al.  Comparison of esophageal manometric characteristics in asymptomatic subjects and symptomatic patients with high-amplitude esophageal peristaltic contractions. , 1987, The American journal of gastroenterology.

[26]  J. Richter,et al.  Apparent complete lower esophageal sphincter relaxation in achalasia. , 1986, Gastroenterology.

[27]  R. D. Henderson,et al.  Ultrastructure of the esophageal muscle in achalasia and diffuse esophageal spasm. , 1983, American journal of clinical pathology.

[28]  W. dodds 1976 Walter B. Cannon Lecture: current concepts of esophageal motor function: clinical implications for radiology. , 1977, AJR. American journal of roentgenology.

[29]  T. Ferguson,et al.  Giant muscular hypertrophy of the esophagus. , 1969, The Annals of thoracic surgery.