Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico.
Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico.
PLoS One. 2021 Mar 15;16(3):e0248106. doi: 10.1371/journal.pone.0248106. eCollection 2021.
Achalasia is a disease characterized by the inability to relax the esophageal sphincter due to a degeneration of the parasympathetic ganglion cells located in the wall of the thoracic esophagus. Achalasia has been associated with extraesophageal dysmotility, suggesting alterations of the autonomic nervous system (ANS) that extend beyond the esophagus. The purpose of the present contribution is to investigate whether achalasia may be interpreted as the esophageal manifestation of a more generalized disturbance of the ANS which includes alterations of heart rate and/or blood pressure. Therefore simultaneous non-invasive records of the heart inter-beat intervals (IBI) and beat-to-beat systolic blood pressure (SBP) of 14 patients (9 female, 5 male) with achalasia were compared with the records of 34 rigorously screened healthy control subjects (17 female, 17 male) in three different conditions: supine, standing up, and controlled breathing at 0.1 Hz, using a variety of measures in the time and spectral domains. Significant differences in heart rate variability (HRV) and blood pressure variability (BPV) were observed which seem to be due to cardiovagal damage to the heart, i.e., a failure of the ANS, as expected according to our hypothesis. This non-invasive methodology can be employed as an auxiliary clinical protocol to study etiology and evolution of achalasia, and other pathologies that damage ANS.
贲门失弛缓症是一种疾病，其特征是由于位于胸食管壁的副交感神经节细胞退化，食管括约肌无法放松。贲门失弛缓症与食管外运动障碍有关，这表明自主神经系统（ANS）的改变不仅局限于食管。本研究的目的是探讨贲门失弛缓症是否可以被解释为更广泛的 ANS 紊乱的食管表现，包括心率和/或血压的改变。因此，我们比较了 14 例贲门失弛缓症患者（9 名女性，5 名男性）和 34 名经过严格筛选的健康对照者（17 名女性，17 名男性）在三种不同情况下的心脏间搏动间隔（IBI）和搏动间收缩压（SBP）的非侵入性同步记录：仰卧位、站立位和以 0.1Hz 控制呼吸，使用时频域中的多种测量方法。观察到心率变异性（HRV）和血压变异性（BPV）的显著差异，这些差异似乎是由于心脏的迷走神经损伤，即 ANS 的衰竭，这与我们的假设相符。这种非侵入性方法可以作为一种辅助临床方案，用于研究贲门失弛缓症和其他损伤 ANS 的病理的病因和演变。
