Functional dyspepsia and irritable bowel syndrome in patients with achalasia and its association with non-cardiac chest pain and a decreased health-related quality of life.

OBJECTIVE: In patients with achalasia, little is known about symptoms of the gastrointestinal tract other than the esophagus. The purpose of this study was to determine the prevalence of two functional disorders, functional dyspepsia (FD) and irritable bowel syndrome (IBS), in a group of treated achalasia patients and to assess the additional impact of these disorders on health-related quality of life (HRQoL). MATERIAL AND METHODS: Questionnaires assessing the Rome II criteria for FD and IBS together with the Eckardt clinical symptom score and RAND-36 were sent to 171 treated achalasia patients. RESULTS: Of these patients, 76.6% returned their questionnaires. In the group of achalasia patients, 23% fulfilled the criteria for FD (Dutch general population 13-14%), and 21% fulfilled the criteria for IBS (Dutch general population 1-6%). The prevalence of frequent chest pain (at least weekly) was higher in patients with FD and/or IBS than in those without these symptoms (54.2% versus 28.2%; p=0.004). Female patients with achalasia and with frequent chest pain showed a higher probability of fulfilling the FD and/or IBS criteria (adjusted OR 2.90 (1.18-7.14) and 3.35 (1.4-8.1), respectively; both with p <0.05). Patients fulfilling the FD and/or IBS criteria scored a lower HRQoL on the RAND-36 subscales--pain, social functioning, and vitality--as compared with patients not fulfilling these criteria (p <0.006). CONCLUSIONS; Symptoms of FD and IBS in patients with treated achalasia are common and have a negative impact on HRQoL. Therefore, this has to be included in the standard evaluation of achalasia patients. The association with chest pain suggests a mutual underlying mechanism.

Increased intragastric pressure gradients are involved in the occurrence of acid reflux in gastroesophageal reflux disease.

OBJECTIVE: Increased pressure gradients across the esophagogastric junction (DeltaEGJp) play a role in gastroesophageal flow during TLESR. The aim of this study was to further explore DeltaEGJp in patients with gastroesophageal reflux disease (GERD) and controls. MATERIAL AND METHODS: Twenty GERD patients were studied along with 20 control subjects. High resolution manometry and pH recording were performed 1 h before and 2 h after a liquid meal (500 ml/300 kcal). DeltaEGJp was calculated at the start of a TLESR and at 180, 60, and 10 s before TLESR. RESULTS: DeltaEGJp at the start of a TLESR and at 180, 60, and 10 s before TLESR was markedly increased in GERD patients compared with that in control subjects (9.9 mmHg and 7.5 mmHg, respectively; p<0.05). Whilst intragastric pressure gradients in GERD patients were increased compared with those in controls (4.6 mmHg and 2.5 mmHg, respectively; p<0.01), intraesophageal pressure gradients were similar in both groups. Furthermore, in controls, first- and second-hour postprandial intragastric pressures were decreased compared with in fasting periods (1.9 +/- 0.4 mmHg and 2.1 +/- 0.4 mmHg versus 3.5 +/- 0.4 mmHg; p<0.05), while this was not observed in GERD patients. CONCLUSIONS: In GERD patients, DeltaEGJp is greater than that in controls both before and during TLESR. This phenomenon is caused by increased intragastric pressure and might contribute to increased rates of acid reflux during TLESR in GERD patients.