Achalasia history and symptoms: Difference between revisions

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{{Achalasia}}
{{Achalasia}}
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==Overview==
==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 [[cough|coughing]] when lying in a horizontal position.
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 [[Aspiration|aspirated]] into the [[lungs]]. Some people may also experience [[cough|coughing]] when lying in a horizontal position.


==History and Symptoms==
==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.


* Primarily result from the increased tone of the LES.
===Symptoms===
*[[Regurgitation]] of undigested food   
 
*[[Cough]]ing, especially when reclining or lying down   
*[[Dyspnea]]<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref><ref name="pmid18614976">{{cite journal| author=Dughera L, Cassolino P, Cisarò F, Chiaverina M| title=Achalasia. | journal=Minerva Gastroenterol Dietol | year= 2008 | volume= 54 | issue= 3 | pages= 277-85 | pmid=18614976 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18614976  }} </ref>
*[[Weight loss]] due to inadequate nutrient intake   
 
*Non-cardiac [[chest pain]]s (NCCP), which may radiate to the back, jaw, neck, and arms   
*[[Dysphagia]] for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
*Some patients also experience [[heartburn]] or frequent [[hiccup]]s
*[[Regurgitation]] of undigested food occurs in 76-91% of patients<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume= | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
* Dysphagia for solids and liquids is the most common feature, being seen in 91 % and 85% respectively.
*[[Cough]] mainly when lying down in 30%<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
*:* The specificity of dysphagia for liquids is relatively high, although it can be seen in other diseases such as progressive systemic sclerosis.
*[[Aspiration]] in 8%<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090 }} </ref>
*:* 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).
*[[Weight loss]] due to inadequate nutrient intake (in 35-91%) <ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090 }} </ref>
* Difficulty belching is seen in 85 % of patients and likely results from failure of the UES to relax.
*[[Chest pain]] that may radiate to the back, jaw, neck, and arms in 25-64% <ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090 }} </ref>
* 40 % of patients describe weight loss, regurgitation, chest pain and heartburn.
*[[Heartburn]] in 18-52%<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
* Patients often adopt certain behaviors to enhance esophageal emptying such as lifting the neck or throwing their shoulders back.
*[[Hiccup]]
* 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.
* Difficulty belching is seen in 85 % of patients and likely results from failure of the UES to relax<ref name="pmid5574797">{{cite journal| author=Vantrappen G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J| title=Treatment of achalasia with pneumatic dilatations. | journal=Gut | year= 1971 | volume= 12 | issue= 4 | pages= 268-75 | pmid=5574797 | doi= | pmc=PMC1411631 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5574797  }} </ref>
 
===ACG Clinical Guideline: Diagnosis and Management of Achalasia<ref name="pmid23877351">{{cite journal| author=Vaezi MF, Pandolfino JE, Vela MF| title=ACG clinical guideline: diagnosis and management of achalasia. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 8 | pages= 1238-49; quiz 1250 | pmid=23877351 | doi=10.1038/ajg.2013.196 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23877351  }} </ref>===
{| class="wikitable"
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''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'').<nowiki>"</nowiki>
|-
|}


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
[[Category:Gastroenterology]]
[[Category:Otolaryngology]]
 
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{{WH}}

Latest revision as of 15:04, 27 November 2017

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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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