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 20 May 2018

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News

Symptoms of achalasia do not correlate with radiographic findings

Symptoms of achalasia do not correlate with radiographic findings concludes a paper in the August issue of The American Journal of Gastroenterology.

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Constriction of the lower portion of the esophagus, or achalasia, is due to an inability of the sphincter muscles to relax.

Its symptoms include difficulty in swallowing, chest pain, vomiting and heartburn, with dysphagia being a hallmark of the condition.

When frequent or marked, dysphagia is believed to be a good predictor of the clinical and radiographic severity of the disease.

A research team from the Hospital of the University of Pennsylvania, Philadelphia, USA, has published data they have collected, evaluating the presence and severity of dysphagia and other symptoms in achalasia, and attempting to correlate these symptoms with findings on barium studies.

Dr Michael E. Blam and his co-authors reviewed the symptoms and radiographs of 38 patients with confirmed achalasia.

Dysphagia - initial symptom of achalasia in only 39% of patients
The American Journal of Gastroenterology

20 patients were reviewed prospectively and 18 retrospectively.

The number of typical and atypical symptoms both initially and at the time of the barium esophagogram was tallied, with the severity of typical symptoms at the time of the esophagogram being scored on a point system.

A scoring system was also devised to rate the severity of the radiographic findings, and then symptoms and radiographic findings were compared.

The researchers found dysphagia was the initial symptom in only 39% of patients, whereas heartburn, regurgitation, and slow eating occurred initially in 24%, 24% and 16% of patients, respectively.

At the time of the barium esophagogram, all symptoms were reported by a greater percentage of patients than at presentation.

The median time period between initial symptoms and symptoms reported at the time of the barium esophagogram was 48 months (range 2-360 months).

At the time of the barium esophagogram, the most frequently reported symptoms were slow eating and regurgitation (79% each).

These were followed in order of frequency by dysphagia (76%), and stereotyped movements (including arching of the neck and shoulders, raising of the arms, standing and sitting straight, and walking) with meals (60%).

The mean number of initial achalasia-related symptoms per patient was 1.34 and increased to 5.50 at the time of the barium esophagogram.

The mean typical symptoms score at the time of the barium esophagogram was 3.4.

Most patients (97%) reported a greater number of achalasia symptoms at the time of the barium esophagogram than initially, despite a mean total radiological score of only 2.58 (out of a maximum of 10 points).

The researchers found there to be no statistically significant relationship between the total number of symptoms at the time of the barium esophagogram and the total radiographic score, and between the typical symptom score at the time of the barium esophagogram and the total radiographic score, by Spearman coefficient.

Commenting of the findings of the study, Dr Blam said, "Achalasia is a disease with many atypical and subtle symptoms, both initially and over time."

He continued, "Dysphagia is initially present in only 39% of patients and is not the most frequently reported symptom over time."

"Neither the severity nor the total number of achalasia-related symptoms correlates with the severity of radiographic findings."

Am J Gastroenterol 2002; 97(8): 1916-1923
13 August 2002

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