Diffuse spasm and muscular hypertrophy of the lower esophagus

Esophageal ganglia and smooth muscle in the elderly

Esophageal motor dysfunction is a common finding in elderly persons, but its etiology remains unknown. We examined the histology of Auerbach's plexus and esophageal smooth muscle in autopsy material from young and old subjects. There was a significant decrease in ganglion cells per square centimeter (1685 +/- 115.9) in old subjects when compared to young controls (2253 +/- 216.9) (P less than 0.05). Lymphocytic infiltration of Auerbach's plexus was commonly observed in both groups of patients, but heavy lymphocytic infiltration was slightly more common in elderly subjects. No difference was found in thickness of esophageal smooth muscle between young and old subjects. It is concluded that diminution of ganglion cells rather than smooth muscle atrophy may explain the frequent occurrence of esophageal motor dysfunction in elderly persons.

Diffuse spasm of the esophagus

During the past ten years 7 men and 15 women with diffuse esophageal spasm have been seen at the Duke University Medical Center. Dysphagia and severe substernal pain were the two characteristic symptoms. Eleven of the 22 patients were treated with a long esophageal myotomy. Two had a diverticulum of the lower esophagus excised in addition, while 6 had an associated sliding hiatal hernia repaired. Three patients in whom the diagnosis was made retrospectively all had an epiphrenic diverticulum excised without a myotomy; in 1 an esophageal leak occurred. These 3 patients still have mild symptoms of their diffuse esophageal spasm. The results of myotomy have been satisfactory. Although this operation does not correct the cause of the disorder, the improvement in symptoms makes it worthwhile in selected patients.