A New Method for the Detection of Incomplete Lower Esophageal Sphincter Relaxation in Patients with Achalasia

Abstract

Background: In patients with early stages of achalasia manometry is of significant diagnostic value. Technically, however, measurement of lower esophageal sphincter (LES) relaxation is not always easy. Accordingly, we looked for a simpler way of measuring incomplete LES relaxation. Methods: In 186 consecutive patients referred to esophageal motility testing the esophageal body base-line pressure was measured during continuous swilling of 180 ml fluid within 20 sec. Results: Seventeen of the 186 patients had achalasia. Fourteen of these patients were compliant for the swill test, and all had a positive test, characterized by a steady increase in base-line pressure with negative deflections on deglutition. All non-achalasia patients could complete the test, which was negative in all except one patient, who had a severe peptic stricture. Conclusions: The swill test is diagnostic for incomplete lower esophageal relaxation in achalasia in compliant patients without organic stenosis.