Esophageal Symptoms and Lumbosacral Back Pain

Abstract

Background and AimsEsophageal symptoms, i.e., heartburn, regurgitation, dysphagia, and chest pain are common in the general population. Also common are symptoms of back pain, related to pathology in the lumbosacral spine. The right crus of the diaphragm that forms the esophageal hiatus, originates from lumbar spine, may be affected by lumbar spine pathology resulting in esophageal symptoms. We studied whether there was an association between esophageal symptoms and spine symptoms. MethodsTwo patient groups of 150 each were investigated; Group 1 (ES); patients referred to the esophageal manometry study for assessment of esophageal symptoms, Group 2 (SC); patients undergoing screening colonoscopy (control group). Both groups completed standardized questionnaires assessing esophageal and spine symptoms. ResultsBack pain was reported by 74% of patients in the ES as compared to 55% of patients in SC group. 30% of patients in the SC group reported one or more esophageal symptom and these patients were regrouped with the ES group, resulting in 2 groups ES1 and SC1, with and without esophageal symptoms, respectively. ES1 group was 3.3 times more likely to experience back pain compared to the SC1 group (95% CI: 1.95-5.46). Thoracolumbar was the most common site of pain in both groups. Pain score was greater for the group with esophageal symptoms compared to controls. Narcotic intake for most patients in the ES1 group was for back pain. ConclusionA strong association between esophageal symptoms and thoracolumbar back pain raises the possibility that structural and functional changes in the esophageal hiatus muscles, related to thoracolumbar spine pathology leads to esophageal dysmotility and symptoms.