Clinical Approach to Achalasia of the Esophagus from the Viewpoint of Gastrointestinal Hormone
Twenty-seven patients with achalasia of the esophagus were treated at the Department of Surgery II, Yamaguchi University Hospital.
Lower esophageal sphincter pressure (LESP) was measured and the response to exogenous gastrointestinal hormones were examined in patients with achalasia and in controls. Gastrin increased the LESP and secretin decreased the LESP in both achalasia patients and in controls. Achalasia patients showed hypersensitivity to gastrin induced LESP and hypersensitivity to secretin reduced LESP compared to controls. Twenty-four of 27 patients underwent the modified Jekler-Lhotka’s operation which consist myectomy and antireflux fundoplication. Gastroscintigraphy showed delayed retention of food in the esophagus before surgery and smooth emptying into the stomach after surgery. Long-term efficacy of this procedure was 91.7%. Specimens from myectomized LES were examined to study the pathophysiology of achalasia. The amount of vasoactive intestinal polypeptide (VIP) in the specimen was measured by radioimmunoassay and the specimen was also examined immunohistochemically. The specimens from achalasia patients have less radioimmunoreactive VIP, fewer VIP cells, and fibers were observed in Auerbach’s plexus in the LES. Decreased VIP in the LES may cause incomplete relaxation of achalasia esophagus.
KeywordsVasoactive Intestinal Polypeptide Lower Esophageal Sphincter Pressure Gastrointestinal Hormone Esophageal Achalasia Achalasia Patient
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