Extraesophageal autonomic dysfunction in patients with achalasia.

A disagreement exists as to whether extraintestinal parasympathetic autonomic function is altered in patients with esophageal achalasia. Therefore, we assessed autonomic dysfunction in esophageal achalasia and considered the most relevant parameters of parasympathetic autonomic function in these patients. In a prospective study, heart rate variation and pupillary function were investigated in 15 patients with achalasia of the esophagus and in 15 controls by application of a battery of standardized autonomic function tests. Significant differences between patients and controls were detected for various parameters of heart rate variation and pupillometry. When compared to values obtained from large groups of healthy subjects, none of the controls but 11 patients had at least one abnormal parameter of parasympathetic autonomic function. It is suggested that in esophageal achalasia parasympathetic dysfunction that extends beyond the gastrointestinal tract can be frequently detected. This finding supports the view of a generalized alteration of the autonomic nervous system in achalasia.