Which patient history is characteristic of achalasia?

Updated: Dec 29, 2017
  • Author: Eric A Gaumnitz, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Note the following:

  • Progressive dysphagia for both solids and liquids is the hallmark of achalasia. Dysphagia for solids is more common than for liquids.

  • Retrospectively, symptoms are present on average as long as 6 years prior to presentation.

  • Regurgitation of food retained in the proximal dilated esophagus is a common occurrence, especially at night, requiring patients to sleep using multiple pillows or upright in a chair. This symptom worsens as the esophagus dilates with time.

  • Chest pain may be another early symptom, characterized by a squeezing retrosternal pain radiating to the neck, jaw, arms, or back. The chest pain may worsen with food and can awaken patients from sleep.

  • A sensation of heartburn may be reported by 30% of patients and is assumed to be related to retained food fermentation and lactic acid.

  • Emotional stress or rapid eating may worsen all of the symptoms described above.

  • Weight loss is common with achalasia; however, the loss is usually slight.

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