title: Improvement of respiratory symptoms following Heller myotomy for achalasia.
abstract: BACKGROUND
  Although patients with achalasia complain mainly of dysphagia, we have observed that they also have a high rate of respiratory problems. We hypothesized that the latter may be due to poor esophageal clearance leading to aspiration. This study examines the effect of Heller myotomy on these symptoms.
  
  
  METHODS
  We studied the course of 111 patients with achalasia who underwent Heller myotomy between 1994 and 2008 and who agreed to participate in this study. All patients completed a questionnaire postoperatively assessing the preoperative and postoperative prevalence and severity of symptoms using visual analog scales. Patients were divided into two groups: one that included all those with respiratory symptoms (dyspnea, hoarseness, cough, wheezing, sore throat, and/or a history of asthma or pneumonia) prior to myotomy and one that included those without those symptoms.
  
  
  RESULTS
  All patients presented with dysphagia as their primary complaint, and 63 (57%) reported respiratory symptoms or disease prior to surgery. There were no significant differences in preoperative characteristics between those with and without respiratory manifestations. After a median follow-up of 71 months (range 9-186 months), 55 (87%) patients reported durable improvement of dysphagia. The frequency and severity of all respiratory symptoms decreased significantly. Twenty-four of the 29 patients (82%) who reported a history of pneumonia prior to surgery did not experience recurrent episodes after Heller myotomy.
  
  
  CONCLUSIONS
  A Heller myotomy is effective in improving esophageal emptying in patients with achalasia. This results in sustained improvement of dysphagia and associated respiratory symptoms/diseases. This suggests that respiratory symptoms/diseases in these patients are likely caused by esophageal retention of food and secretions, and then aspiration.
authors.affiliation: University of Washington Department of Surgery, Seattle, WA, USA. skhandel@u.washington.edu
authors.forename: Saurabh
authors.initials: S
authors.lastname: Khandelwal
authors.forename: Rebecca
authors.initials: R
authors.lastname: Petersen
authors.forename: Roger
authors.initials: R
authors.lastname: Tatum
authors.forename: Huseyin
authors.initials: H
authors.lastname: Sinan
authors.forename: Daniel
authors.initials: D
authors.lastname: Aaronson
authors.forename: Fernando
authors.initials: F
authors.lastname: Mier
authors.forename: Ana V
authors.initials: AV
authors.lastname: Martin
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pellegrini
authors.forename: Brant K
authors.initials: BK
authors.lastname: Oelschlager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications* / Q000601:surgery; D004931:Esophageal Achalasia / Q000150:complications* / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D053120:Respiratory Aspiration / Q000150:complications*; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000601:surgery; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013906:Thoracoscopy; D016896:Treatment Outcome; D055815:Young Adult