title: Functional dyspepsia and irritable bowel syndrome in patients with achalasia and its association with non-cardiac chest pain and a decreased health-related quality of life.
abstract: OBJECTIVE
  In patients with achalasia, little is known about symptoms of the gastrointestinal tract other than the esophagus. The purpose of this study was to determine the prevalence of two functional disorders, functional dyspepsia (FD) and irritable bowel syndrome (IBS), in a group of treated achalasia patients and to assess the additional impact of these disorders on health-related quality of life (HRQoL).
  
  
  METHODS
  Questionnaires assessing the Rome II criteria for FD and IBS together with the Eckardt clinical symptom score and RAND-36 were sent to 171 treated achalasia patients.
  
  
  RESULTS
  Of these patients, 76.6% returned their questionnaires. In the group of achalasia patients, 23% fulfilled the criteria for FD (Dutch general population 13-14%), and 21% fulfilled the criteria for IBS (Dutch general population 1-6%). The prevalence of frequent chest pain (at least weekly) was higher in patients with FD and/or IBS than in those without these symptoms (54.2% versus 28.2%; p=0.004). Female patients with achalasia and with frequent chest pain showed a higher probability of fulfilling the FD and/or IBS criteria (adjusted OR 2.90 (1.18-7.14) and 3.35 (1.4-8.1), respectively; both with p <0.05). Patients fulfilling the FD and/or IBS criteria scored a lower HRQoL on the RAND-36 subscales--pain, social functioning, and vitality--as compared with patients not fulfilling these criteria (p <0.006). CONCLUSIONS; Symptoms of FD and IBS in patients with treated achalasia are common and have a negative impact on HRQoL. Therefore, this has to be included in the standard evaluation of achalasia patients. The association with chest pain suggests a mutual underlying mechanism.
authors.affiliation: Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands. r.frankhuisen@umcutrecht.nl
authors.forename: Rutger
authors.initials: R
authors.lastname: Frankhuisen
authors.forename: Margot A
authors.initials: MA
authors.lastname: Van Herwaarden
authors.forename: Roy
authors.initials: R
authors.lastname: Heijkoop
authors.forename: Astrid
authors.initials: A
authors.lastname: Baron
authors.forename: Reinoud
authors.initials: R
authors.lastname: Vermeijden
authors.forename: André J P M
authors.initials: AJ
authors.lastname: Smout
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Melvin
authors.initials: M
authors.lastname: Samsom
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000150:complications / Q000453:epidemiology*; D004415:Dyspepsia / Q000150:complications / Q000453:epidemiology*; D004931:Esophageal Achalasia / Q000150:complications*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires