# Cardiovascular Autonomic Deficits in Different Types of Achalasia

## TL;DR

This study found that all types of achalasia involve reduced autonomic nervous system function, with the most severe deficits in type I achalasia.

## Contribution

The study is the first to compare autonomic dysfunction across different types of achalasia using comprehensive autonomic function tests.

## Key findings

- All types of achalasia show reduced parasympathetic and baroreflex-independent sympathetic reactivity.
- Cardiac autonomic tone is diminished in achalasia, but sympathovagal balance is preserved.
- Type I achalasia exhibits the most severe autonomic dysfunction compared to types II and III.

## Abstract

Background and objective

Achalasia cardia is a primary esophageal motility disorder, and the etiopathology of this disease's progression is not known. Moreover, autonomic dysfunction has not been studied in different types of achalasia. In light of this, we aimed to address this lack of data in this study.

Methods

The diagnosis of achalasia was done using high-resolution esophageal manometry (HRM)-based Chicago classification v4.0. Autonomic function tests (AFT) such as the head-up tilt test, deep breathing test (DBT), Valsalva maneuver (VM), handgrip test (HGT), and cold pressor test (CPT), as well as the heart rate variability (HRV) test, were performed among the cohort and the results were compared with those of 39 age- and sex-matched healthy controls.

Results

AFT and HRV tests were done on 62 patients (30 achalasia type I, 28 type II, and 4 type III) and compared with 39 age- and sex-matched healthy controls. The mean duration of symptoms, high Eckardt score, and dysphagia were most common in type I achalasia, followed by type II and III. The results of AFT showed a generalized loss of parasympathetic and baroreflex-independent sympathetic reactivity in all types of achalasia. However, baroreflex-dependent cardiovascular adrenergic reactivity was normal. Regarding cardiac autonomic tone, there was a loss of parasympathetic and sympathetic influence, but sympathovagal balance was maintained. The severity of the loss of autonomic functions was higher in type I, followed by type II.

Conclusions

In all types of achalasia, parasympathetic reactivity, baroreflex-independent sympathetic reactivity, and cardiac autonomic tone were lower compared to healthy controls, and the severity of dysfunction increased during the progression of the disease from type II to type I.