Pathophysiology of Esophago-gastric Junction and Operation in Patients with Achalasia

Hiroyasu Makuuchi, Takao Machimura, Yoshio Sho, Hideo Shimada, Kyoichi Mizutani, Koji Kanno, Takashi Sugiuhara, Tetsuji Sasaki, Tomoo Tajima, Toshio Mitomi

Department of Surgery, Tokai University School of Medicine

Manometrsic studies on the esophagus were conducted in patients with achalasia. Deglutitive relaxation in the lower esophageal sphincter (LES) could not be detected in 80.8% of the patients and primary peristaltic waves of the esophagus disappeared in 93.1%. However incomplete deglutitive relaxation in LES and primary peristaltic waves were detected in several patients with achalasia. High LES pressure was found in 66.7% high resting pressure in the esophagus in 83.3% and abnormal contraction in 59.3% of the patients. These are secondary findings on esophago-gastric function in ahalasia. The treatment of first choice for achalasia is balloon dilation. Surgery should be used for the patients with sigmoid type or marked dilation, in addition to the patients in whom is not very effective balloon dilation. Medication should be considered when the dysphagia is made worse by emotional conflicts. We have performed the Heller's long myectomy together with fundapplication of 2/3 the circumference of the esophagus, and Hill's posterior fundopexy in 10 patients. All of them had good passage of food without regurgitation after the operation.

Key words
esophageal achalasia, manometry, lower esophageal sphincter function

Reprint requests
Hiroyasu Makuuchi Department of Surgery, Tokai University School of Medicine
Bouseidai, Isehara, 259-11 JAPAN

Accepted
April 18, 1990

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