Achalasia and chest pain

Effect of laparoscopic Heller myotomy

Silvana Perretta, Piero M. Fisichella, Carlos A Galvani, Maria V. Gorodner, Lawrence W. Way, Marco G. Patti

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Some patients with achalasia complain of chest pain in addition to dysphagia and regurgitation. Chest pain is said to be most common in young patients who have been symptomatic for a short time, and who often have vigorous achalasia (distal esophageal amplitude ≥37 mm Hg). Although pneumatic dilatation is reported to improve chest pain in 20% of patients, the effect of laparoscopic Heller myotomy on chest pain is unknown. The aim of this study was to determine the following in achalasia: (1) the prevalence of chest pain; (2) the clinical and manometric profiles of patients with chest pain; and (3) the effect of laparoscopic Heller myotomy. Between 1990 and 2001, a total of 211 patients with achalasia were studied (upper gastrointestinal series, esophagoduodenoscopy, and manometry). A total of 117 patients (55%) had chest pain in addition to dysphagia and regurgitation; 63 (54%) of these 117 patients underwent laparoscopic Heller myotomy and Dor fundoplication. Median follow up was 24 months. Age (49±16 years vs. 51±14 years [mean±SD]), duration of symptoms (71±91 months vs. 67±92 months [mean±SD]), and presence of vigorous achalasia (50% vs. 47%) were similar in those with and without chest pain. Ten (16%) of the 63 patients with chest pain who underwent Heller myotomy had vigorous achalasia. Postoperatively chest pain resolved in 84% and improved in 11% of patients. There was no difference in clinical outcome between patients with and without vigorous achalasia. These data demonstrate the following: (1) chest pain was present in 55% of patients with esophageal achalasia; (2) chest pain was not related to age, duration of symptoms, or manometric findings; and (3) laparoscopic Heller myotomy improved chest pain in 95% of patients, regardless of the manometric findings. Thus laparoscopic Heller myotomy was highly effective in treating achalasia with chest pain.

Original languageEnglish (US)
Pages (from-to)595-598
Number of pages4
JournalJournal of Gastrointestinal Surgery
Volume7
Issue number5
DOIs
StatePublished - Jul 2003
Externally publishedYes

Fingerprint

Esophageal Achalasia
Chest Pain
Deglutition Disorders
Fundoplication
Manometry
Dilatation

Keywords

  • Chest pain
  • Esophageal achalasia
  • Esophageal manometry
  • Heller myotomy
  • Pneumatic dilatation
  • Vigorous achalasia

ASJC Scopus subject areas

  • Surgery

Cite this

Achalasia and chest pain : Effect of laparoscopic Heller myotomy. / Perretta, Silvana; Fisichella, Piero M.; Galvani, Carlos A; Gorodner, Maria V.; Way, Lawrence W.; Patti, Marco G.

In: Journal of Gastrointestinal Surgery, Vol. 7, No. 5, 07.2003, p. 595-598.

Research output: Contribution to journalArticle

Perretta, Silvana ; Fisichella, Piero M. ; Galvani, Carlos A ; Gorodner, Maria V. ; Way, Lawrence W. ; Patti, Marco G. / Achalasia and chest pain : Effect of laparoscopic Heller myotomy. In: Journal of Gastrointestinal Surgery. 2003 ; Vol. 7, No. 5. pp. 595-598.
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abstract = "Some patients with achalasia complain of chest pain in addition to dysphagia and regurgitation. Chest pain is said to be most common in young patients who have been symptomatic for a short time, and who often have vigorous achalasia (distal esophageal amplitude ≥37 mm Hg). Although pneumatic dilatation is reported to improve chest pain in 20{\%} of patients, the effect of laparoscopic Heller myotomy on chest pain is unknown. The aim of this study was to determine the following in achalasia: (1) the prevalence of chest pain; (2) the clinical and manometric profiles of patients with chest pain; and (3) the effect of laparoscopic Heller myotomy. Between 1990 and 2001, a total of 211 patients with achalasia were studied (upper gastrointestinal series, esophagoduodenoscopy, and manometry). A total of 117 patients (55{\%}) had chest pain in addition to dysphagia and regurgitation; 63 (54{\%}) of these 117 patients underwent laparoscopic Heller myotomy and Dor fundoplication. Median follow up was 24 months. Age (49±16 years vs. 51±14 years [mean±SD]), duration of symptoms (71±91 months vs. 67±92 months [mean±SD]), and presence of vigorous achalasia (50{\%} vs. 47{\%}) were similar in those with and without chest pain. Ten (16{\%}) of the 63 patients with chest pain who underwent Heller myotomy had vigorous achalasia. Postoperatively chest pain resolved in 84{\%} and improved in 11{\%} of patients. There was no difference in clinical outcome between patients with and without vigorous achalasia. These data demonstrate the following: (1) chest pain was present in 55{\%} of patients with esophageal achalasia; (2) chest pain was not related to age, duration of symptoms, or manometric findings; and (3) laparoscopic Heller myotomy improved chest pain in 95{\%} of patients, regardless of the manometric findings. Thus laparoscopic Heller myotomy was highly effective in treating achalasia with chest pain.",
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