Can isolated pain be one of the initial features of achalasia ?

D. Couturier (Paris)

Two possibilities must be distinguished here : pain associated with other symptoms, nearly always dysphagia, and isolated pain.

The first situation is quite common and is found in about 5 to 6 cases in 10. In these cases, the combination of symptoms points directly to the esophagus.

The second situation is much more deceptive. It is true that in some cases achalasia is manifested by isolated chest pain, but this is rare. Taking together all the primary motor disorders of the esophagus responsible for chest pain, achalasia comes last with less than 10 p. cent of cases. This is far behind the syndrome of painful peristalsis (40-45 % of cases), unclassifiable motor disorders (25-35 %), hypertension of the lower sphincter (15-20 %) and the disease of diffuse spasm (10-15%).