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Under usual manometrics (a
dry swallow and an empty esophagus), esophageal achalasia
is classic.
Is realistic an empty esophagus?
Is a dry swallow a realistic stimulus?
Techniques
In order to explore entirely
the inferior sphincter, six open-tip catheters, one centimeter
apart, were used. In 58 patients with “achalasia”,
60 ml of water were instilled. Afterwards, a small
dosage of acetyl-beta-methylcholine was injected subcutaneously
in a few patients.
Results
In 84% of the 58 patients,
as the body of the esophagus was progresively instilled,
the pressure did not rise only within the body, but also
within the sphincter, remaining higher within
the sphincter that within the body, up to 50 millibars,
at which point the pressures became equal.
On emptying the body, pressures
returned to normal both within the body and within the
sphincter, but after a delay of several seconds within
the sphincter.
The site of the reaction
was the upper end of the sphincter. The sphincter seemed
to lengthen proximally. This was filmed by cineradiography.
After succesful Heller operations, the reaction disappeared.
After injecting a small
dose of acetyl-beta-methylcholine, the reaction was strikingly
increased, both within the sphincter and within the body:
the chemical stimulus sensitized the esophagus to the
mechanical stimulus, confirming the law of denervation
outlined by Claude Bernard and confirmed by Cannon.
Conclusion
Achalasia,
as a phenomenon, was an artifact: an observation under inadequate
conditions.
Such a sign
was
suitable for the name of the disease?
Better using the lesions, naming the disease “esophageal
plexatrophy”?
Better naming
the
principal sign “esophageal
reactive spasm”?
References
- Besançon F.
Technical changes leading to a new theory to replace esophageal
achalasia.
Am J Dig Dis 1968; 13 (4): 361-367
- Besançon F, Janin B, Debray C. Physiopathologie
du méga-œsophage. Le cardiospasme réactionnel.
Arch Mal App Dig 1962; 51: 1543-1555
- Besançon F, Janin B, Debray C. Le
méga-œsophage, cardiospasme réactionnel.
Données électromanographiques et cinéradiométriques.
Sem Hôp 1962; 38: 1555-1564
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