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Digestive Diseases and Sciences

, Volume 49, Issue 11–12, pp 1818–1821 | Cite as

Achalasia Presenting After Operative and Nonoperative Trauma

  • Rupa N. Shah
  • James L. Izanec
  • David M. Friedel
  • Peter Axelrod
  • Henry P. Parkman
  • Robert S. Fisher
Article

Abstract

Achalasia has been described following fundoplication and is attributed to vagal nerve damage during surgery. Similarly, other traumatic events to the distal esophagus may be linked to the development of achalasia. Operative and nonoperative trauma as a possible factor in the development of achalasia was studied. A retrospective analysis of patients with achalasia (n=64) at our institution was performed. Collected data included age, gender, symptoms, and history of operative and nonoperative traumatic events. Comparisons were made to a group of patients with similar symptoms but normal esophageal manometry (n=73). Achalasia was diagnosed by manometry in 125 patients over a 6-year period. All patients with complete medical records (n=64) were studied. A history of operative or nonoperative trauma to the upper gastrointestinal tract prior to the development of symptomatic achalasia was present in 16 of 64 (25%). Significantly fewer patients (9.5%) with symptoms of dysphagia, but normal manometry and upper endoscopy, had precedent trauma to the upper gastrointestinal tract (P &< 0.05). All cases of nonoperative trauma occurred in motor vehicle accidents. Cases of operative trauma included coronary artery bypass surgery (n=4), bariatric surgery (n=2), fundoplication (n=3), heart/lung transplantation (n=1), and others (n=5). Patients with proven achalasia and a history of trauma were more likely to have chest pain (RR, 4.5; P = 0.012) but less likely to have regurgitation (RR, 0.51; P = 0.01) or nausea/vomiting (RR, 0.0; P = 0.27) than those without a history of antecedent trauma. In this series, significantly more patients with achalasia had a history of preceding trauma than did patients with similar symptoms and normal esophageal manometry. Following trauma, patients may be at increased risk for developing achalasia, possibly from neuropathic dysfunction due to vagal nerve damage. Patients with posttraumatic achalasia may have symptoms which differ from those of other achalasia patients.

achalasia vagus nerve motor vehicle accident-2 

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References

  1. 1.
    Anggiansah A, Bright NF, McCullagh M, et al.: Transition from nutcracker esophagus to achalasia. Dig Dis Sci 35(9):1162–1166, 1990CrossRefPubMedGoogle Scholar
  2. 2.
    Shiflett DW, Wu WC, Ott DJ: Transition from nonspecific motility disorder to achalasia. Am J Gastroenterol 73:325–328, 1980PubMedGoogle Scholar
  3. 3.
    Vantrappen G, Janssens J, Hellemans J, et al.: Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 76:450–457, 1979PubMedGoogle Scholar
  4. 4.
    Narducci F, Bassotti G, Gaburri M, et al.: Transition from nutcracker esophagus to diffuse esophageal spasm. Am J Gastroenterol 80:242–244, 1985PubMedGoogle Scholar
  5. 5.
    Robson K, Rosenberg S, Lembo T: GERD progressing to diffuse esophageal spasm and then to achalasia. Dig Dis Sci 45(1):110–113, 2000CrossRefPubMedGoogle Scholar
  6. 6.
    Spechler SJ, Souza RF, Rosenberg SJ, et al.: Heartburn in patients with achalasia. Gut 37:305–308, 1995CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Smart HL, Mayberry JF, Atkinson M: Achalasia following gastro-oesophageal reflux. J Roy Soc Med 79:71–73, 1986CrossRefPubMedGoogle Scholar
  8. 8.
    Dufresne CR, Jeyasingham K, Baker RR: Achalasia of the cardia associated with pulmonary sarcoidosis. Surgery 94:32–35, 1983PubMedGoogle Scholar
  9. 9.
    Boruchowicz A, Canva-Delcambre V, Guillemot F, et al.: Sarcoidosis and achalasia: A fortuitous association? Am J Gastroenterol 91(2):413–414, 1996PubMedGoogle Scholar
  10. 10.
    Suris X, Moya F, Panes J, et al.: Achalasia of the esophagus in secondary amyloidosis. Am J Gastroenterol 88(11):1959–1960, 1993PubMedGoogle Scholar
  11. 11.
    Lopez-Liuchi JV, Kraytem A, Uldry PY: Oesophageal achalasia secondary to pleural mesothelioma. J Roy Soc Med 92:25–26, 1999CrossRefGoogle Scholar
  12. 12.
    Tucker HJ, Snape WJ, Cohen S: Achalasia secondary to carcinoma: Manometric and clinical features. Ann Intern Med 89(3):315–318, 1978CrossRefPubMedGoogle Scholar
  13. 13.
    DiBaise JK, Quigley EM: Tumor-related dysmotility gastrointestinal dysmotility syndromes associated with tumors. Dig Dis Sci 43(7):1369–1401, 1998CrossRefPubMedGoogle Scholar
  14. 14.
    Poulin EC, Diamant NE, Kortan P, et al.: Achalasia developing years after surgery for reflux disease: Case reports, laparoscopic treatment, and review of achalasia syndromes following antireflux surgery. J Gastrointest Surg 4(6):626–631, 2000CrossRefPubMedGoogle Scholar
  15. 15.
    Duntemann TJ, Dresner DM: Achalasia-like syndrome presenting after highly selective vagotomy. Dig Dis Sci 40(9):2081–2083, 1995CrossRefPubMedGoogle Scholar
  16. 16.
    Stylopoulos N, Bunker CJ, Rattner DW: Development of achalasia secondary to laparascopic nissen fundoplication. J Gastrointest Surg 6(3):368–376, 2002CrossRefPubMedGoogle Scholar
  17. 17.
    Smith B: The neurological lesions in achalasia of the cardia. Gut 11:388–391, 1970CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Csendes A, Smok G, Braghetto I, et al.: Gastroesophageal sphincter pressure and histologic changes in distal esophagus in patients with achalasia of the esophagus. Dig Dis Sci 30:941–945, 1985CrossRefPubMedGoogle Scholar
  19. 19.
    Goldblum JR, White RI, Orringer MB, et al.: Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol 18:327–337, 1994CrossRefPubMedGoogle Scholar
  20. 20.
    Hornby PJ, Abrahams TP, Partosoedarso ER: Central mechanisms of lower esophageal sphincter control. Gastroenterol Clin 31(4): S11–S20, 2002CrossRefGoogle Scholar
  21. 21.
    Schwartz TW: Pancreatic polypeptide: A unique model for vagal control of endocrine systems. J Auton Nerv Syst 9:99–111, 1983CrossRefPubMedGoogle Scholar
  22. 22.
    Schwartz TW, Stenquist B, Olbe L: Cephalic phase of pancreatic polypeptide secretion studied by sham feeding in man. Scand J Gastroenterol 14:313–320, 1979CrossRefPubMedGoogle Scholar
  23. 23.
    Balaji NS, Crookes PF, Banki F, et al.: A safe and noninvasive test for vagal integrity revisited. Arch Surgery 137:954–959, 2002CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • Rupa N. Shah
    • 1
  • James L. Izanec
    • 1
  • David M. Friedel
    • 1
  • Peter Axelrod
    • 2
  • Henry P. Parkman
    • 1
  • Robert S. Fisher
    • 1
  1. 1.Division of Gastroenterology, Department of MedicineTemple University HospitalPhiladelphiaUSA
  2. 2.Division of Infectious Diseases, Department of MedicineTemple University School of MedicinePhiladelphiaUSA

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