Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy.
BACKGROUND
Dysphagia and regurgitation are considered typical symptoms of achalasia. However, there is mounting evidence that some achalasia patients may also experience respiratory symptoms such as cough, wheezing, and hoarseness.


OBJECTIVE
The aims of this study were to determine: (1) what percentage of achalasia patients experience respiratory symptoms and (2) the effect of a laparoscopic Heller myotomy and Dor fundoplication on the typical and respiratory symptoms of achalasia.


METHODS
Between May 2008 and December 2015, 165 patients with achalasia were referred for treatment to the Center for Esophageal Diseases of the University of Chicago. Patients had preoperatively a barium swallow, endoscopy, and esophageal manometry. All patients underwent a Heller myotomy and Dor fundoplication.


RESULTS
Based on the presence of respiratory symptoms, patients were divided into two groups: group A, 98 patients (59%) without respiratory symptoms and group B, 67 patients (41%) with respiratory symptoms. The preoperative Eckardt score was similar in the two groups (6.5 ± 2.1 versus 6.4 ± 2.0). The mean esophageal diameter was 27.7 ± 10.8 mm in group A and 42.6 ± 20.1 mm in group B (P < .05). The operation consisted of a myotomy that extended for 5 cm on the esophagus and 2.5 cm onto the gastric wall. At a median postoperative follow-up of 17 months, the Eckardt score improved significantly and similarly in the two groups (0.3 ± 0.8 versus 0.3 ± 1.0). Respiratory symptoms improved or resolved in 62 patients (92.5%).


CONCLUSIONS
The results of this study showed that: (1) respiratory symptoms were present in 41% of patients; (2) patients with respiratory symptoms had a more dilated esophagus; and (3) surgical treatment resolved or improved respiratory symptoms in 92.5% of patients. This study underlines the importance of investigating the presence of respiratory symptoms along with the more common symptoms of achalasia and of early treatment before lung damage occurs.
1 Department of Surgery and Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
Ciro
C
Andolfi
2 Department of Gastroenterology, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
Robert T
RT
Kavitt
3 Department of Surgery, Escola Paulista de Medicina, Federla University of Sao Paulo , Sao Paulo, Brazil .
Fernando A M
FA
Herbella
1 Department of Surgery and Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
Marco G
MG
Patti
D000328:Adult; D000368:Aged; D003371:Cough / Q000209:etiology* / Q000601:surgery; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004931:Esophageal Achalasia / Q000150:complications / Q000473:pathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006685:Hoarseness / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012135:Respiratory Sounds / Q000209:etiology*; D016896:Treatment Outcome