Alimentary TractChest pain in achalasia: Patient characteristics and clinical course☆,☆☆
Section snippets
Patients
In 1981, we commenced a prospective long-term observation in patients with newly diagnosed achalasia.10 By July 1997, 101 consecutive patients were admitted to the study and were followed up at 2-year intervals. With the exception of a single patient who was lost to follow-up 5 years after the diagnosis of achalasia, complete information was available in all other patients (99%). In each instance, the diagnosis of primary achalasia was confirmed by radiographic, manometric, and endoscopic
Prevalence of chest pain
At initial presentation, 64 patients gave a history of episodic retrosternal pain, whereas 37 patients had never had such symptoms. Forty-seven percent of all patients with chest pain reported that these attacks predominantly occurred in the middle of the night; 23% had most episodes during the day, and the remaining 30% did not notice a significant diurnal variation in pain frequency. Pain attacks were reported to last from a few minutes to almost 24 hours, were not related to the ingestion of
Discussion
This study shows that two thirds of all patients with achalasia complain of episodic chest pain that poorly responds to conventional therapy but tends to spontaneously diminish with advancing age. Although the cause of this symptom remains the subject of speculation, its preferential occurrence in young patients as well as its clinical course suggest that it is an age-dependent phenomenon that is perhaps related to supersensitivity and/or degeneration of sensory neurons.
The mechanism producing
References (24)
- et al.
Syndrome of vigorous achalasia: clinical and physiologic observations
Dis Chest
(1967) - et al.
Histopathologic features in esophagomyotomy specimens from patients with achalasia
Gastroenterology
(1996) - et al.
Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings
Gastroenterology
(1991) - et al.
Predictors of outcome in patients with achalasia treated by pneumatic dilation
Gastroenterology
(1992) - et al.
High amplitude peristaltic contractions associated with chest pain and/or dysphagia
Gastroenterology
(1979) - et al.
Spontaneous non-cardiac chest pain: evaluation by 24-hour ambulatory esophageal motility and pH monitoring
Gastroenterology
(1988) - et al.
Oral nifedipine in the treatment of non-cardiac chest pain in patients with the nutcracker esophagus
Gastroenterology
(1987) - et al.
Botulinum toxin for achalasia: long-term outcome and predictors of response
Gastroenterology
(1996) - et al.
Treatment of achalasia with pneumatic dilatations
Gut
(1971) - et al.
Esophagomyotomy versus forceful dilation for achalasia of the esophagus: results in 899 patients
Ann Thorac Surg
(1979)
Long-term results of esophagomyotomy for achalasia of esophagus
Arch Surg
Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh
Gut
Cited by (0)
- ☆
Address requests for reprints to: Volker F. Eckardt, M.D., Dotzheimer Strasse 14-18, 65185 Wiesbaden, Germany. Fax: (49) 611-370972.
- ☆☆
This article includes parts of the doctoral thesis of Bernd Stauf.