Abstract

SUMMARY1. Hematemesis and melena followed with in 12 hours a positive Mecholyl test on a patient with achalasia of the gastroesophageal segment and ectasia of the esophagus with active esophagitis.2. The finding of inflammatory degeneration of the autonomic plexuses of the esophagus places this patient in that category of functional obstruction of the lower esophagus where lack of relaxation of the gastroesophageal segment to the stimulus of a descending peristaltic wave is the basic defect, and the reaction of the esophagus to Mecholyl obeys Cannon's Law of Denervation.83. This type of dysergia, characterized by inflammatory degeneration of the autonomic plexuses, has been shown by others to involve various portions of the gastrointestinal and genitourinary tracts and myocardium, and probably represents, therefore, a manifestation of a generalized autonomic neuropathy.4. We suggest a classification of functional obstruction at the gastroesophageal segment.5. A Mecholyl test should be done in cases of functional obstruction of the gastroesophageal segment to help differentiate the dysfunction of esophageal motility so that more specific therapy can be instituted.