1999 Volume 53 Pages 62-65
A 28-year-old man was admitted to our hospital due to dysphagia during meals. He was diagnosed as having achalasia in 1996. The dysphagia improved following administration of nifedipine (10mg) . The effect of nifedipine administration diminished in May 1997, and dysphagia recurred.
Upper gastrointestinal endoscopy revealed normal findings. Esophagography showed mild dilatation of the middle and lower esophagus and mucus pooling. On conventional esophageal manometric examination, basal lower esophageal sphincter (LES) pressure was 55mmHg. LES relaxation on swallowing was 80%, and residual LES pressure after swallowing was 12mmHg. Basal esophageal body pressure was higher than the intragastric pressure. All esophageal contractions on swallowing 5 ml of water were simultaneous. The amplitude of simultaneous contraction was 60～100mmHg. In general, a patient with simultaneous contraction is considered to have diffuse esophageal spasm (DES) . However, proposed criteria for the manometric diagnosis of DES include the presence of simultaneous esophageal contractions and the preservation of some peristalsis. Base on these results, we diagnosed this patient with DES-like nonspecific esophageal motility disturbance (NEMD) .
To treat NEMD, we performed endoscopic pneumatic dilatation (140-170mmHg, 3 min, 3 times) . A subsequent decrease in basal LES pressure (55 → 25mmHg) and residual LES pressure after swallowing (12 → 2mmHg) were observed. After endoscopic dilatation, dysphagia during meals disappeared entirely.
