Highamplitude contractions inthemiddle third oftheoesophagus: amanometric marker of chronic alcoholism?

Background-Oesophageal motorabnormalities havebeenreported inalcoholism. Aim-Toinvestigate theeffects ofchronic alcoholismand its withdrawalon oesophageal disease. Patients-23 chronicalcoholic patients (20men andthreewomen;meanage43, range23to54). Methods-Endoscopy, manometry,and 24hourpH monitoring 7-10daysandsix monthsafterethanol withdrawal. Tests forautonomic andperipheral neuropathy werealsoperformed. Motility andpH tracings werecompared withthoseofage andsexmatchedcontrol groups: healthy volunteers, nutcracker oesophagus, and gastro-oesophageal reflux disease. Results-14 (61%)alcoholic patients had refluxsymptoms,andendoscopy with biopsyshowedoesophageal inflammationin10patients. Onepatient hadan asymptomatic squamouscellcarcinoma. Oesophageal motility studiesin the alcoholic patients showedthatperistaltic amplitude inthemiddlethird was>150 mm Hg (95th percentile (P95)ofhealthy controls) in13(57%), theratiolower/ middleamplitude was 0.9 inallcontrol groups), andthelower oesophageal sphincter was hypertensive (>23.4 mm Hg,P95ofhealthy controls) in 13(57%).Allthreeabnormalities were presentinfive(22%). Abnormalreflux (percentreflux time>2.9, P95ofhealthy controls) wasshownin12(52%)alcoholic patients, andwasunrelated toperistaltic dysfunction. Subclinical neuropathy in10 patients didnoteffect oesophageal abnormalities. Oesophageal motility abnormalities persisted atsixmonthsinsixpatients withongoingalcoholism, whereasthey reverted towardsnormalin 13 who remained abstinent; reflux, however, was unaffected. Conclusions-Oesophageal peristaltic dysfunction andreflux arefrequent in alcoholism. Highamplitude contractions inthemiddlethirdoftheoesophagus seemtobeamarkerofexcessive alcohol consumption, andtendtoimprove with abstinence. (Gut1996; 38:655-662)