Achalasia history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.