Achalasia history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:Rim Halaby, Twinkle Singh, M.B.B.S. [2] Kiran Singh, M.D. [3], Ahmed Younes M.B.B.CH [4]

Overview

The main symptoms of achalasia are dysphagia, regurgitation of undigested food, retrosternal chest pain and weight loss. Dysphagia involves both fluids and solids and progressively worsens over time. The chest pain experienced, also known as cardiospasm and non-cardiac chest pain can often be mistaken for a heart attack. Food and liquid, including saliva, can be retained in the esophagus and may be aspirated into the lungs. Some people may also experience coughing when lying in a horizontal position.

History and Symptoms

History

  • Achalasia is a rare swallowing disorder. It most commonly starts with difficulty swallowing both liquids and solids and becomes worse with time.
  • The specificity of dysphagia for liquids is relatively high, although it can be seen in other diseases such as progressive systemic sclerosis.
  • Forty percent of patients describe weight loss, regurgitation, chest pain and heartburn.
  • Due to the slowly progressive nature of the disease, many patients have symptoms for years prior to seeking medical attention.
  • Patients often adopt certain behaviors to enhance esophageal emptying such as lifting the neck or throwing their shoulders back.

Symptoms

  • Dysphagia for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively[3]
  • Regurgitation of undigested food occurs in 76-91% of patients[3]
  • Cough mainly when lying down in 30%[3]
  • Aspiration in 8%[3]
  • Weight loss due to inadequate nutrient intake (in 35-91%) [3]
  • Chest pain that may radiate to the back, jaw, neck, and arms in 25-64% [3]
  • Heartburn in 18-52%[3]
  • Hiccup
  • Difficulty belching is seen in 85 % of patients and likely results from failure of the UES to relax[4]

ACG Clinical Guideline: Diagnosis and Management of Achalasia[5]

"1. Achalasia must be suspected in those with dysphagia to solids and liquids and in those with regurgitation unresponsive to an adequate trial of proton pump inhibitor (PPI) therapy

(strong recommendation, low-quality evidence)."

References

  1. Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  2. Dughera L, Cassolino P, Cisarò F, Chiaverina M (2008). "Achalasia". Minerva Gastroenterol Dietol. 54 (3): 277–85. PMID 18614976.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
  4. Vantrappen G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J (1971). "Treatment of achalasia with pneumatic dilatations". Gut. 12 (4): 268–75. PMC 1411631. PMID 5574797.
  5. Vaezi MF, Pandolfino JE, Vela MF (2013). "ACG clinical guideline: diagnosis and management of achalasia". Am J Gastroenterol. 108 (8): 1238–49, quiz 1250. doi:10.1038/ajg.2013.196. PMID 23877351.



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