Chest pain in achalasia: Patient characteristics and clinical course

Background & Aims: In this prospective study, the prevalence of episodic pain in patients with achalasia was investigated, risk factors for its occurrence were determined, and its long-term clinical course was evaluated. Methods: Over an 18-year period, patients with newly diagnosed achalasia were followed up at 2-year intervals. At the first visit and after each treatment, all patients underwent manometric, endoscopic, and radiographic examinations. In addition, structured interviews were performed during each patient visit and at 2-year intervals. Potential risk factors for the presence or absence of chest pain were evaluated with the use of a logistic model. To determine the evolution of this symptom, Kaplan-Meier life-table analyses were performed. Results: Among 101 patients with achalasia, 64 reported chest pain and 37 had never had this symptom. Neither manometric nor radiographic findings predicted the occurrence of retrosternal pain. However, patients with chest pain were significantly younger than those without, and they had a shorter duration of symptoms. Treatment with pneumatic dilatation or myotomy effectively diminished dysphagia but had little effect on the occurrence of retrosternal pain. However, over a course of several years, chest pain diminished in most patients and disappeared in a minority of them. Conclusions: Chest pain is a common symptom of achalasia and predominantly affects younger patients. Its cause remains unknown, and no treatment exists to effectively relieve this symptom. However, with advancing age, the frequency of chest pain will spontaneously diminish in most patients.