Extraesophageal symptoms are common in patients with Achalasia

Unexplained respiratory symptoms are most commonly explained by extra-esophageal manifestations of gastro-esophageal reflux disease and such patients are often submitted to prolonged proton pump inhibitor therapy. It is less well known, that similar symptoms may occur in patients with achalasia secondary to food retention in the dilated esophagus and subsequent micro-aspiration, or to the compression of the airways by the food filled dilated esophagus. The aim of the study was to determine the prevalence of respiratory symptoms in our patients with achalasia. Methods: Two hundred and three (M/F: 94/113, mean age: 58 (17 – 90) years) consecutive patients with achalasia were retrospectively evaluated. The diagnosis of achalasia was established by standard water perfusion manometry between 1992 and 2015. Symptom analysis was carried out on the basis of the patient's data file. Results: One hundred and thirty-five patients (66.5%) had only esophageal symptoms such as dysphagia, regurgitation, esophageal burning and chest pain. The remaining 68 patients (33.5%) reported the occurrence of at least one respiratory symptom, including cough in 40 patients (19.70%), nocturnal cough in 14 patients (6.9%), hoarseness in 10 patients (4.93%). Ten patients (4.93%) had bronchial asthma. Other respiratory symptoms like wheezing, sore throat, choking, stridor, recurrent pulmonary or upper airway infections infections, croaking, etc. were observed in 33 (16.26%). Conclusions: Similarly to gastro-esophageal reflux disease, a wide variety of respiratory symptoms may occur and are common in patients with achalasia. This observation highlights the importance of esophageal function testing in patients with suspected extra-esophageal reflux disease and failure to the initial proton pump inhibitor therapy.