Amyloidosis Mimics Achalasia's Effect on Lower Esophageal Sphincter

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 1989 Apr 1

PMID 2702892

Citations 7

Authors

J R Lefkowitz

D L Brand

M D Schuffler

W R Brugge

Affiliations

Soon will be listed here.

Abstract

Esophageal involvement in systemic amyloidosis is common. Manometric studies have been few in number and have revealed a variety of findings compatible with deposition of amyloid in myopathic as well as neuropathic patterns. This report describes a patient with primary amyloid whose esophageal dysfunction was limited to the lower esophageal sphincter, with both a hypertensive sphincter and impaired relaxation after swallows. Pharmacologic testing confirmed a mild abnormality of the inhibitory pathway to the LES with an intact excitatory pathway and sphincter muscle. This case suggests that amyloidosis, like idiopathic achalasia and carcinoma of the lower esophagus, can produce dysphagia by selective impairment of the inhibitory neural pathway to the lower esophageal sphincter.

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References

Wallin L, Boesby S, Madsen T . Effect of metoclopramide on oesophageal peristalsis and gastro-oesophageal sphincter pressure. A study in normal subjects. Scand J Gastroenterol. 1979; 14(8):923-7. View

Eisen H . Primary systemic amyloidosis. Am J Med. 2010; 1:144-60. DOI: 10.1016/0002-9343(46)90032-0. View

CASSELLA R, BROWN Jr A, SAYRE G, ELLIS Jr F . ACHALASIA OF THE ESOPHAGUS: PATHOLOGIC AND ETIOLOGIC CONSIDERATIONS. Ann Surg. 1964; 160:474-87. PMC: 1408778. DOI: 10.1097/00000658-196409000-00010. View

Dilawari J, Misiewicz J . Action of oral metoclopramide on the gastrooesophageal junction in man. Gut. 1973; 14(5):380-2. PMC: 1412692. View

Stanciu C, Bennett J . Metoclopramide in gastrooesophageal reflux. Gut. 1973; 14(4):275-9. PMC: 1412597. DOI: 10.1136/gut.14.4.275. View

Albibi R, McCallum R . Metoclopramide: pharmacology and clinical application. Ann Intern Med. 1983; 98(1):86-95. DOI: 10.7326/0003-4819-98-1-86. View

Gilat T, Revach M, SOHAR E . Deposition of amyloid in the gastrointestinal tract. Gut. 1969; 10(2):98-104. PMC: 1552807. DOI: 10.1136/gut.10.2.98. View

Burakoff R, Rubinow A, Cohen A . Esophageal manometry in familial amyloid polyneuropathy. Am J Med. 1985; 79(1):85-9. DOI: 10.1016/0002-9343(85)90550-9. View

Dodds W, Dent J, Hogan W, Patel G, Toouli J, Arndorfer R . Paradoxical lower esophageal sphincter contraction induced by cholecystokinin-octapeptide in patients with achalasia. Gastroenterology. 1981; 80(2):327-33. View

10.

Misiewicz J, Waller S, ANTHONY P, GUMMER J . Achalasia of the cardia: pharmacology and histopathology of isolated cardiac sphincteric muscle from patients with and without achalasia. Q J Med. 1969; 38(149):17-30. View

11.

Dodds W, Dent J, Hogan W, Arndorfer R . Effect of atropine on esophageal motor function in humans. Am J Physiol. 1981; 240(4):G290-6. DOI: 10.1152/ajpgi.1981.240.4.G290. View

12.

Behar J, Brand D, Brown F, Castell D, Cohen S, Crossley R . Cimetidine in the treatment of symptomatic gastroesophageal reflux: a double blind controlled trial. Gastroenterology. 1978; 74(2 Pt 2):441-8. View

13.

TUCKER H, Snape Jr W, Cohen S . Achalasia secondary to carcinoma: manometric and clinical features. Ann Intern Med. 1978; 89(3):315-8. DOI: 10.7326/0003-4819-89-3-315. View

14.

Reddy A, Wright R, Wheeler G, Nazer H . Nonobstructive gastroparesis in amyloidosis improved with metoclopramide. Arch Intern Med. 1983; 143(2):247-8. View

15.

Rubinow A, Burakoff R, Cohen A, Harris L . Esophageal manometry in systemic amyloidosis. A study of 30 patients. Am J Med. 1983; 75(6):951-6. DOI: 10.1016/0002-9343(83)90874-4. View

16.

Behar J, Biancani P . Effect of cholecystokinin-octapeptide on lower esophageal sphincter. Gastroenterology. 1977; 73(1):57-61. View

17.

Gilat T, Spiro H . Amyloidosis and the gut. Am J Dig Dis. 1968; 13(7):619-33. DOI: 10.1007/BF02232969. View

18.

Costigan D, Clouse R . Achalasia-like esophagus from amyloidosis. Successful treatment with pneumatic bag dilatation. Dig Dis Sci. 1983; 28(8):763-5. DOI: 10.1007/BF01312569. View

19.

Fisher R, Malmud L, Roberts G, Lobis I . The lower esophageal sphincter as a barrier to gastroesophageal reflux. Gastroenterology. 1977; 72(1):19-22. View

20.

Holloway R, Dodds W, Helm J, Hogan W, Dent J, Arndorfer R . Integrity of cholinergic innervation to the lower esophageal sphincter in achalasia. Gastroenterology. 1986; 90(4):924-9. DOI: 10.1016/0016-5085(86)90869-3. View