J Neurogastroenterol Motil  
Clinical Characteristics of Patients with Untreated Achalasia
Han Ho Jeon1, 1, Jie-Hyun Kim2, Young Hoon Youn2, Hyojin Park2*, Jeffrey L Conklin3
1Division of Gastroenterolgy, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Ilsan, Korea, 2Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, 3Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California, USA
Correspondence to: Hyojin Park, MD, PhD
Institute of Gastroente rology , Department of Internal medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
Tel : +82-2019 -3318, Fax: +82-2-3463 -3882,
E-mail: HJPARK21@yuhs.ac
Received: October 13, 2016; Revised: January 3, 2017; Accepted: January 22, 2017; Published online: March 28, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims Patients with untreated achalasia frequently complain of heartburn and regurgitation. The diagnosis of achalasia might be delayed because these symptoms are misinterpreted as gastroesophageal reflux. We aim to evaluate the clinical presentation, radiologic, and manometric findings in patient untreated achalasia.
Methods The records of patients diagnosed with primary achalasia between July 2004 and January 2012 at Gangnam Severance Hospital, Seoul, Korea were evaluated. We reviewed their clinical history and the results of barium esophagogram, endoscopy, and esophageal transit scintigraphy. We also compared the clinical and radiologic and manometric findings of patients according to heartburn symptoms and proton pump inhibitor use.
Results Our study included a total of 64 patients with a median age of 44.5. The median duration of symptoms was 23.5 months. Sixty-four patients (100%) had dysphagia, 49 (76.6%) had regurgitation, 35 (54.7%) had chest pain, and 38 (59.4%) had heartburn. Typical clinical features of GERD such as regurgitation, heartburn and chest pain were observed in more than 50% of achalasia patients. Proton pump inhibitors were prescribed for 16 patients (25%) on the assumption that they had refractory GERD. Patients with heartburn were more likely to experience weight loss (P = 0.009), regurgitation (P = 0.001), or chest pain (P = 0.019).
Conclusions Heartburn, regurgitation, and chest pain were commonly observed in patients with untreated achalasia. Patients with heartburn were more likely to experience weight loss regurgitation or chest pain.
Keywords: Diagnosis, Esophageal achalasia, Gastroesophageal reflux


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