Gastroenterology

Gastroenterology

Volume 116, Issue 6, June 1999, Pages 1300-1304
Gastroenterology

Alimentary Tract
Chest pain in achalasia: Patient characteristics and clinical course,☆☆

Presented in part at the annual meeting of the American Gastroenterological Association, New Orleans, Louisiana, May 1998.
https://doi.org/10.1016/S0016-5085(99)70493-2Get rights and content

Abstract

Background & Aims: In this prospective study, the prevalence of episodic pain in patients with achalasia was investigated, risk factors for its occurrence were determined, and its long-term clinical course was evaluated. Methods: Over an 18-year period, patients with newly diagnosed achalasia were followed up at 2-year intervals. At the first visit and after each treatment, all patients underwent manometric, endoscopic, and radiographic examinations. In addition, structured interviews were performed during each patient visit and at 2-year intervals. Potential risk factors for the presence or absence of chest pain were evaluated with the use of a logistic model. To determine the evolution of this symptom, Kaplan–Meier life-table analyses were performed. Results: Among 101 patients with achalasia, 64 reported chest pain and 37 had never had this symptom. Neither manometric nor radiographic findings predicted the occurrence of retrosternal pain. However, patients with chest pain were significantly younger than those without, and they had a shorter duration of symptoms. Treatment with pneumatic dilatation or myotomy effectively diminished dysphagia but had little effect on the occurrence of retrosternal pain. However, over a course of several years, chest pain diminished in most patients and disappeared in a minority of them. Conclusions: Chest pain is a common symptom of achalasia and predominantly affects younger patients. Its cause remains unknown, and no treatment exists to effectively relieve this symptom. However, with advancing age, the frequency of chest pain will spontaneously diminish in most patients.

GASTROENTEROLOGY 1999;116:1300-1304

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

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  • 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.

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