Achalasia:
The symptoms of achalasia are typically:
- Dysphagia
- Chest pain
- Weight loss
- Cough
Dysphagia - Difficulty in swallowing is the commonest presenting feature in achalasia.
This affects solids more than soft food or liquids. With time the difficulty affects liquids and solids equally when nothing is easily swallowed.
Meals take longer and longer to consume and typically the patient is the first to start eating and the last to finish.
Regurgitation may occur in 80 to 90% and some patients learn to induce it to relieve pain.
Chest pain - This occurs in 25 to 50% of patients with achalasia. It occurs after eating and is described as retrosternal. It is more prevalent in early disease.
Heart burn is common and may be aggravated by treatment.
Loss of weight - Occurs as the patient's intake dwindles.
It may also suggest malignancy that may co-exist in the chronically inflamed oesophagus due to the continued of undigested foodstuff.
Cough - Nocturnal cough and even inhalation of refluxed contents is a feature of later disease.
The pool of saliva and ingested liquid which has not passed into the stomach is able to pass back up the oesophagus into the mouth and even into the lungs when the patient is recumbant.