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Clearance mechanisms of the aperistaltic oesophagus: the “pump gun” hypothesis
  1. R Tutuian1,
  2. D Pohl1,
  3. D O Castell2,
  4. M Fried3
  1. 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
  2. 2Division of Gastroenterology-Hepatology, Medical University of South Carolina, Charleston SC, USA
  3. 3Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to:
    Dr R Tutuian
    University Hospital Zurich, Division of Gastroenterology and Hepatology, Raemistrasse 100, CH-8091 Zurich, Switzerland; radu.tutuian{at}usz.ch

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We describe the pattern of oesophageal pressure changes noted during high resolution manometry in a patient with achalasia. Our data indicate that longitudinal muscle contraction of the oesophagus is the major mechanism responsible for emptying the oesophageal contents against a poorly relaxing lower oesophageal sphincter. This phenomenon may enable patients with achalasia to empty the oesophagus and thus to relieve discomfort and maintain an adequate nutritional status.

Achalasia (Greek for “lack of relaxation”) is a primary oesophageal motility disorder characterised by the absence of oesophageal peristalsis due to damages of the myenteric plexus. Typically, patients with achalasia report difficulties in swallowing both liquids and solids (dysphagia) but young patients may initially complain of chest pain and regurgitation. These patients have mostly normal endoscopy (that is, no food retention) and initially do not loose weight, which leads to a delay in establishing this diagnosis.

Clearance of the aperistaltic oesophagus of patients with achalasia is thought to occur passively …

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