Variations in clinical presentation of patients with esophageal contraction abnormalities

All patients referred over a one-year period for clinical esophageal manometry were asked to carefully characterize their esophageal symptoms on a self-report questionnaire. Seventy-five patients (48%) were found to have one or more of four contraction abnormalities in the distal esophagus which are thought to be associated with esophageal symptoms. Duration of any of the five symptoms sought (chest pain, dysphagia for solids, dysphagia for liquids, heartburn, regurgitation) varied from two weeks to 28 years (median two years). The prevalence of the individual esophageal symptoms was similar for each of the four contraction abnormalities. Chest pain was the most common symptom and did not vary in prevalence with the cumulative number of manometric abnormalities. In contrast, dysphagia for either liquids or solids tended to increase in prevalence with manometric severity. The variation in location of reported chest pain and dysphagia was remarkable. Although heartburn was reported as a presenting symptom by 48%, this symptom was reproduced by acid instillation in less than half of those so studied. We conclude that esophageal symptoms are generally poor predictors of manometric findings within this group and that variations in clinical presentation are common.