ABSTRACT
Achalasia is one of the most common esophageal motility disorder which is characterized by dysphagia and noncardiac chest pain. Esophageal motility disorder has been extensively investigated in recent years as a cause of noncardiac chest pain. The exclusion of cardiac disease is usually based on the presence of normal epicardial coronary arteries. However, myocardial ischemia can occur upon physical stress in patients with normal coronary arteries and is thought to be secondary to dynamic vasoconstriction of coronary artery microcirculation. The disturbances of vasomotor control and the abnormalities of sympathetic nervous system play a role in generation of microvascular angina. Some patients with achalasia exhibit an abnormality in the autonomic nerveous system that extends beyond the gastrointestinal tract. Recently, we experienced two cases of achalasia accompanied by microvascular angina. They had persistent chest pain even after successful endoscopic treatments for achalasia and showed microvascular angina on subsequent coronary angiography and/or exercise stress test.