title: Achalasia and chest pain: effect of laparoscopic Heller myotomy.
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.
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California 94143-0788, USA.
authors.forename: Silvana
authors.initials: S
authors.lastname: Perretta
authors.forename: Piero M
authors.initials: PM
authors.lastname: Fisichella
authors.forename: Carlos
authors.initials: C
authors.lastname: Galvani
authors.forename: Maria V
authors.initials: MV
authors.lastname: Gorodner
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Way
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D002637:Chest Pain / Q000453:epidemiology* / Q000601:surgery; D004106:Dilatation; D004931:Esophageal Achalasia / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015995:Prevalence; D013997:Time Factors; D016896:Treatment Outcome