Achalasia history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The main symptoms of achalasia are dysphagia that is described as difficulty in swallowing, 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

• Primarily result from the increased tone of the LES.
• Regurgitation of undigested food
• Coughing, especially when reclining or lying down
• Weight loss due to inadequate nutrient intake
• Non-cardiac chest pains (NCCP), which may radiate to the back, jaw, neck, and arms
• Some patients also experience heartburn or frequent hiccups
• Dysphagia for solids and liquids is the most common feature, being seen in 91 % and 85% respectively.

  • The specificity of dysphagia for liquids is relatively high, although it can be seen in other diseases such as progressive systemic sclerosis.
  • Due to the slowly progressive nature of the disease, many patients have symptoms for years prior to seeking medical attention (mean ~ 4.7 years in one study).

• Difficulty belching is seen in 85 % of patients and likely results from failure of the UES to relax.
• 40 % of patients describe weight loss, regurgitation, chest pain and heartburn.
• Patients often adopt certain behaviors to enhance esophageal emptying such as lifting the neck or throwing their shoulders back.
• The incidence of esophageal cancer is controversial in patients with achalasia. Some Swedish studies report an increased incidence, and suggest routine surveillance esophago-gastroduodenoscopy (EGD). This has not been shown to be the case in the U.S., and current recommendations do not include routine EGD.