High prevalence of heartburn and low acid sensitivity in patients with idiopathic achalasia.
BACKGROUND
Heartburn is frequently reported by patients with achalasia before treatment. However, the esophageal sensitivity to acid as a possible mediator of this symptom has not been previously evaluated.


OBJECTIVE
To evaluate the prevalence of gastroesophageal reflux symptoms and the esophageal sensitivity to acid perfusion in patients with untreated achalasia.


METHODS
Forty patients with achalasia were prospectively evaluated. Forty-three patients with gastroesophageal reflux disease comprised the control group (ten of them with Barrett's esophagus). Symptoms were evaluated by a structured clinical questionnaire. Objective assessment was performed by ambulatory 24-h esophageal pH monitoring and endoscopy. Esophageal sensitivity to acid was evaluated by esophageal perfusion of ClH 0.1 N.


RESULTS
Fifteen (37%) of the 40 patients with achalasia presented heartburn, but only four of them had esophagitis and/or abnormal esophageal pH recording. Eight patients had abnormal pH recording. Three patients had esophagitis. The esophagus was sensitive to acid in seven (17%) patients with achalasia, three of them with heartburn and one with abnormal pH recording. In the control group, 40 of 43 (93%) presented heartburn. Acid perfusion was positive in 32 (74%). Sensitivity to acid was lower in patients with achalasia than in those with gastroesophageal reflux disease with or without Barrett's esophagus.


CONCLUSIONS
The prevalence of heartburn in patients with achalasia is high, although its association with objective indicators of gastroesophageal reflux disease is weak. Patients with achalasia have lower esophageal sensitivity to acid than patients with GERD, suggesting that heartburn is does not arise from this condition.
Ponce
Julio
J
Gastroenterology Unit, Hospital Universitari La Fe, Valencia, Spain.
Ortiz
Vicente
V
Maroto
Nuria
N
Ponce
Marta
M
Bustamante
Marco
M
Garrigues
Vicente
V
D000143:Acids; D000293:Adolescent; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology; D004724:Endoscopy; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000453:epidemiology*; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology; D006356:Heartburn / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult
D000143:Acids