Skip to main content
NCBI home page
Gut logoLink to Gut
. 1992 Aug;33(8):1011–1015. doi: 10.1136/gut.33.8.1011

Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh.

P J Howard 1, L Maher 1, A Pryde 1, E W Cameron 1, R C Heading 1
PMCID: PMC1379432  PMID: 1398223

Abstract

With the increasing availability of manometry, patients with achalasia are often referred at an early stage when they lack the classic features of established disease. A prospective five year study of the presenting features of untreated achalasia referred to our department was undertaken. Twenty men and 18 women presented throughout adult life, with a mean age at the time of diagnosis of 44 years (range 17 to 76 years). The presenting symptoms were dysphagia: for solids (100%) and for liquids (97%), chest pain (74%), and weight loss (60%). Endoscopy was reported as normal in 15 patients and achalasia was suggested in only 21 of 33 barium examinations. Fourteen had been treated for gastrooesophageal reflux but none had been misdiagnosed as having cardiac or psychiatric disease. The annual incidence of achalasia in the Lothian region is 0.8/100,000 of population. Persistent dysphagia is the cardinal symptom of achalasia which presents throughout adult life. Nevertheless, recent onset achalasia is often misdiagnosed as gastrooesophageal reflux disease. Because endoscopy is frequently normal and the diagnosis is often not made by radiology, manometric investigation is necessary if the condition is to be recognised and treated at an early stage.

Full text

PDF
1011

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benjamin S. B., Richter J. E., Cordova C. M., Knuff T. E., Castell D. O. Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology. 1983 May;84(5 Pt 1):893–901. [PubMed] [Google Scholar]
  2. Black J., Vorbach A. N., Collis J. L. Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair. Br J Surg. 1976 Dec;63(12):949–953. doi: 10.1002/bjs.1800631215. [DOI] [PubMed] [Google Scholar]
  3. Dellipiani A. W., Hewetson K. A. Pneumatic dilatation in the management of achalasia: experience of 45 cases. Q J Med. 1986 Mar;58(227):253–258. [PubMed] [Google Scholar]
  4. ELLIS F. G. The natural history of achalasia of the cardia. Proc R Soc Med. 1960 Aug;53:663–666. doi: 10.1177/003591576005300824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Earlam R. J., Ellis F. H., Jr, Nobrega F. T. Achalasia of the esophagus in a small urban community. Mayo Clin Proc. 1969 Jul;44(7):478–483. [PubMed] [Google Scholar]
  6. Fellows I. W., Ogilvie A. L., Atkinson M. Pneumatic dilatation in achalasia. Gut. 1983 Nov;24(11):1020–1023. doi: 10.1136/gut.24.11.1020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Grimes O. F., Stephens H. B., Margulis A. R. Achalasia of the esophagus. Am J Surg. 1970 Aug;120(2):198–202. doi: 10.1016/s0002-9610(70)80111-8. [DOI] [PubMed] [Google Scholar]
  8. Howard P. J., Maher L., Pryde A., Heading R. C. Symptomatic gastro-oesophageal reflux, abnormal oesophageal acid exposure, and mucosal acid sensitivity are three separate, though related, aspects of gastro-oesophageal reflux disease. Gut. 1991 Feb;32(2):128–132. doi: 10.1136/gut.32.2.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Jara F. M., Toledo-Pereyra L. H., Lewis J. W., Magilligan D. J., Jr Long-term results of esophagomyotomy for achalasia of esophagus. Arch Surg. 1979 Aug;114(8):935–936. doi: 10.1001/archsurg.1979.01370320067011. [DOI] [PubMed] [Google Scholar]
  10. Kramer P., Harris L. D., Donaldson R. M., Jr Transition from symptomatic diffuse spasm to cardiospasm. Gut. 1967 Apr;8(2):115–119. doi: 10.1136/gut.8.2.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Mayberry J. F., Atkinson M. A study of swallowing difficulties in first degree relatives of patients with achalasia. Thorax. 1985 May;40(5):391–393. doi: 10.1136/thx.40.5.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mayberry J. F., Atkinson M. Studies of incidence and prevalence of achalasia in the Nottingham area. Q J Med. 1985 Aug;56(220):451–456. [PubMed] [Google Scholar]
  13. Mayberry J. F., Atkinson M. Variations in the prevalence of achalasia in Great Britain and Ireland: an epidemiological study based on hospital admissions. Q J Med. 1987 Jan;62(237):67–74. [PubMed] [Google Scholar]
  14. Mayberry J. F., Rhodes J. Achalasia in the city of Cardiff from 1926 to 1977. Digestion. 1980;20(4):248–252. doi: 10.1159/000198446. [DOI] [PubMed] [Google Scholar]
  15. Menzies-Gow N., Gummer J. W., Edwards D. A. Results of Heller's operation for achalasia of the cardia. Br J Surg. 1978 Jul;65(7):483–485. doi: 10.1002/bjs.1800650711. [DOI] [PubMed] [Google Scholar]
  16. Okike N., Payne W. S., Neufeld D. M., Bernatz P. E., Pairolero P. C., Sanderson D. R. Esophagomyotomy versus forceful dilation for achalasia of the esophagus: results in 899 patients. Ann Thorac Surg. 1979 Aug;28(2):119–125. doi: 10.1016/s0003-4975(10)63767-8. [DOI] [PubMed] [Google Scholar]
  17. Pai G. P., Ellison R. G., Rubin J. W., Moore H. V. Two decades of experience with modified Heller's myotomy for achalasia. Ann Thorac Surg. 1984 Sep;38(3):201–206. doi: 10.1016/s0003-4975(10)62237-0. [DOI] [PubMed] [Google Scholar]
  18. Rosenzweig S., Traube M. The diagnosis and misdiagnosis of achalasia. A study of 25 consecutive patients. J Clin Gastroenterol. 1989 Apr;11(2):147–153. doi: 10.1097/00004836-198904000-00007. [DOI] [PubMed] [Google Scholar]
  19. Sawyers J. L., Foster J. H. Surgical considerations in the management of achalasia of the esophagus. Ann Surg. 1967 May;165(5):780–785. doi: 10.1097/00000658-196705000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Smart H. L., Foster P. N., Evans D. F., Slevin B., Atkinson M. Twenty four hour oesophageal acidity in achalasia before and after pneumatic dilatation. Gut. 1987 Jul;28(7):883–887. doi: 10.1136/gut.28.7.883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Stacher G., Kiss A., Wiesnagrotzki S., Bergmann H., Höbart J., Schneider C. Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa. Gut. 1986 Oct;27(10):1120–1126. doi: 10.1136/gut.27.10.1120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Vantrappen G., Hellemans J., Deloof W., Valembois P., Vandenbroucke J. Treatment of achalasia with pneumatic dilatations. Gut. 1971 Apr;12(4):268–275. doi: 10.1136/gut.12.4.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Vantrappen G., Hellemans J., Deloof W., Valembois P., Vandenbroucke J. Treatment of achalasia with pneumatic dilatations. Gut. 1971 Apr;12(4):268–275. doi: 10.1136/gut.12.4.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Vantrappen G., Janssens J., Hellemans J., Coremans G. Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology. 1979 Mar;76(3):450–457. [PubMed] [Google Scholar]
  25. Yon J., Christensen J. An uncontrolled comparison of treatments for achalasia. Ann Surg. 1975 Dec;182(6):672–676. doi: 10.1097/00000658-197512000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES