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.[7] 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.