SpringerLink
Log in

Improvement of Respiratory Symptoms Following Heller Myotomy for Achalasia

  • 2010 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Although patients with achalasia complain mainly of dysphagia, we have observed that they also have a high rate of respiratory problems. We hypothesized that the latter may be due to poor esophageal clearance leading to aspiration. This study examines the effect of Heller myotomy on these symptoms.

Methods

We studied the course of 111 patients with achalasia who underwent Heller myotomy between 1994 and 2008 and who agreed to participate in this study. All patients completed a questionnaire postoperatively assessing the preoperative and postoperative prevalence and severity of symptoms using visual analog scales. Patients were divided into two groups: one that included all those with respiratory symptoms (dyspnea, hoarseness, cough, wheezing, sore throat, and/or a history of asthma or pneumonia) prior to myotomy and one that included those without those symptoms.

Results

All patients presented with dysphagia as their primary complaint, and 63 (57%) reported respiratory symptoms or disease prior to surgery. There were no significant differences in preoperative characteristics between those with and without respiratory manifestations. After a median follow-up of 71 months (range 9–186 months), 55 (87%) patients reported durable improvement of dysphagia. The frequency and severity of all respiratory symptoms decreased significantly. Twenty-four of the 29 patients (82%) who reported a history of pneumonia prior to surgery did not experience recurrent episodes after Heller myotomy.

Conclusions

A Heller myotomy is effective in improving esophageal emptying in patients with achalasia. This results in sustained improvement of dysphagia and associated respiratory symptoms/diseases. This suggests that respiratory symptoms/diseases in these patients are likely caused by esophageal retention of food and secretions, and then aspiration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Akritidis N, Gousis C, Dimos G, Paparounas K. Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia. Chest. 2003; 123(2): p. 608–12.

    Article  PubMed  Google Scholar 

  2. Bello CT, Lewin JR, Norris CM, Farrar GE, Jr. Achalasia (cardiospasm); report of a case with extreme and unusual manifestations. Ann Intern Med. 1950; 32(6): p. 1184–90.

    CAS  PubMed  Google Scholar 

  3. Cramer JP, Sudeck H, Burchard GD. Pulmonary infection with rapidly growing mycobacteria in a singer with achalasia: a case report. J Infect. 2007; 54(4): p. e219–21.

    Article  CAS  PubMed  Google Scholar 

  4. Kwok SC, O’Loughlin EV, Kakakios AM, van Asperen PP. Wheezy swallow: poorly responsive ‘asthma’. J Paediatr Child Health. 2008; 44(1–2): p. 74–7.

    PubMed  Google Scholar 

  5. Mehdi NF, Weinberger MM, Abu-Hasan MN. Achalasia: unusual cause of chronic cough in children. Cough. 2008; 4: p. 6.

    Article  PubMed  Google Scholar 

  6. Travis KW, Saini VK, Osullivan PT. UPPER-AIRWAY OBSTRUCTION AND ACHALASIA OF THE ESOPHAGUS. Anesthesiology. 1981; 54(1): p. 87–88.

    Article  CAS  PubMed  Google Scholar 

  7. Wechalekar MD, Southcott AM. Achalasia cardia presenting as stridor. Respirology. 2008; 13(7): p. 1088–90.

    PubMed  Google Scholar 

  8. Sinan H, Tatum RP, Soares RV, Martin AV, Pellegrini CA, Oelschlager BK. Dis Esophagus. 2010 Nov 12. doi:10.1111/j.1442-2050.2010.01126.x.

  9. Franquet T, Gimenez A, Roson N, et al. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics. 2000; 20(3): p. 673–85.

    CAS  PubMed  Google Scholar 

  10. McArthur MS. Pulmonary complications of benign esophageal disease. Am J Surg. 1986; 151(2): p. 296–9.

    Article  CAS  PubMed  Google Scholar 

  11. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009; 249(1): p. 45–57.

    Article  PubMed  Google Scholar 

  12. Ruffato A, Mattioli S, Lugaresi ML, et al. Long-term results after Heller-Dor operation for oesophageal achalasia. Eur J Cardiothorac Surg. 2006; 29(6): p. 914–9.

    Article  PubMed  Google Scholar 

  13. Ortiz A, de Haro LF, Parrilla P, et al. Very long-term objective evaluation of heller myotomy plus posterior partial fundoplication in patients with achalasia of the cardia. Ann Surg. 2008; 247(2): p. 258–64.

    Article  PubMed  Google Scholar 

  14. Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007; 21(5): p. 713–8.

    Article  CAS  PubMed  Google Scholar 

  15. Heller E. Extramukose Cardioplatic beim chronishen Cardiospasmus mit Dilatation des Oesophagus. Mitt Grenzeg Med Chir. 1913; 27: p. 141.

    Google Scholar 

  16. Tatum RP, Pellegrini CA. How I do it: laparoscopic Heller myotomy with Toupet fundoplication for achalasia. J Gastrointest Surg. 2009; 13(6): p. 1120–4.

    Article  PubMed  Google Scholar 

  17. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg. 2003; 138(5): p. 490–5; discussion 495–7.

    Article  PubMed  Google Scholar 

  18. Woltman TA, Pellegrini CA, Oelschlager BK. Achalasia. Surg Clin North Am. 2005; 85(3): p. 483–93.

    Article  PubMed  Google Scholar 

  19. Ellis FG. The natural history of achalasia of the cardia. Proc R Soc Med. 1960; 53: p. 663–6.

    CAS  PubMed  Google Scholar 

  20. Howard PJ, Maher L, Pryde A, et al. Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut. 1992; 33(8): p. 1011–5.

    Article  CAS  PubMed  Google Scholar 

  21. Ho V, Whiting P. Acute airway obstruction secondary to achalasia mega-oesophagus. Anaesth Intensive Care. 2008; 36(4): p. 582–4.

    CAS  PubMed  Google Scholar 

  22. Akhter J, Newcomb RW. Tracheal obstruction secondary to esophageal achalasia. J Pediatr Gastroenterol Nutr. 1988; 7(5): p. 769–72.

    Article  CAS  PubMed  Google Scholar 

  23. Aslam MI, Sutton CD, Hunter DC. Acute airway compression with achalasia. J Am Coll Surg. 2007; 205(6): p. 813.

    Article  PubMed  Google Scholar 

  24. Chapman S, Weller PH, Campbell CA, Buick RG. Tracheal compression caused by achalasia. Pediatr Pulmonol. 1989; 7(1): p. 49–51.

    Article  CAS  PubMed  Google Scholar 

  25. Dunlop SP, Travis SP. Achalasia presenting as acute stridor. Eur J Gastroenterol Hepatol. 1997; 9(11): p. 1125–8.

    CAS  PubMed  Google Scholar 

  26. Kugelman A, Berkowitz D, Best LA, Bentur L. Upper airway obstruction as a presenting sign of achalasia in childhood. Acta Paediatr. 2000; 89(3): p. 356–8.

    Article  CAS  PubMed  Google Scholar 

  27. Newcomb RW, Akhter J. On tracheal compression by achalasia. Pediatr Pulmonol. 1990; 8(1): p. 61.

    Article  CAS  PubMed  Google Scholar 

  28. Robinson GV, Kanji H, Davies RJ, Gleeson FV. Selective pulmonary fat aspiration complicating oesophageal achalasia. Thorax. 2004; 59(2): p. 180.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Washington Department of Surgery, Seattle, WA, USA

    Saurabh Khandelwal, Rebecca Petersen, Roger Tatum, Huseyin Sinan, Daniel Aaronson, Fernando Mier, Ana V. Martin, Carlos A. Pellegrini & Brant K. Oelschlager

Authors
  1. Saurabh Khandelwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roger Tatum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huseyin Sinan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Aaronson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fernando Mier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ana V. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos A. Pellegrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Brant K. Oelschlager
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saurabh Khandelwal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Khandelwal, S., Petersen, R., Tatum, R. et al. Improvement of Respiratory Symptoms Following Heller Myotomy for Achalasia. J Gastrointest Surg 15, 235–239 (2011). https://doi.org/10.1007/s11605-010-1397-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-010-1397-2

Keywords

Search

Navigation