Faculty Collaboration Database

Comparison of pseudoachalasia and achalasia. Am J Med 1987 Mar;82(3):439-46

Date

03/01/1987

Pubmed ID

3548347

DOI

10.1016/0002-9343(87)90443-8

Scopus ID

2-s2.0-0023614217 (requires institutional sign-in at Scopus site)   211 Citations

Abstract

Malignancies involving the gastric cardia or distal esophagus can result in a clinical syndrome termed pseudoachalasisa that mimics idiopathic achalasia. If not promptly recognized, pseudoachalasia can result in inappropriate pneumatic dilatation of the lower esophageal sphincter segment and delay appropriate treatment of the underlying malignancy. During the past 14 years, six patients with pseudoachalasia and 161 patients with primary idiopathic achalasia were encountered. Pseudoachalasia occurred mainly in the elderly and represented about 9 percent of these patients over 60 years of age with suspected achalasia. Five of the six pseudoachalasia cases were secondary to adenocarcinoma that originated in the gastric fundus, and one was caused by a squamous cell carcinoma of the distal esophagus. Conventional esophageal manometry did not discriminate achalasia from pseudoachalasia. On the other hand, esophagogastroscopy with biopsy resulted in a diagnosis of pseudoachalasia in five of these cases and in 24 of 32 cases reported previously. Ominous endoscopic findings are mucosal ulceration or nodularity, reduced compliance of the esophagogastric junction, or an inability to pass the endoscope into the stomach. Radiographic evaluation, particularly in conjunction with amyl nitrite inhalation, was also useful in discriminating pseudoachalasia from primary achalasia. It is concluded that pseudoachalasia generally mimics idiopathic achalasia imperfectly and can usually be diagnosed prior to surgery by fastidious endoscopic and radiographic examination.

Author List

Kahrilas PJ, Kishk SM, Helm JF, Dodds WJ, Harig JM, Hogan WJ

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Diagnosis, Differential
Esophageal Achalasia
Esophagogastric Junction
Esophagoscopy
Gastroscopy
Humans
Manometry
Methacholine Chloride
Methacholine Compounds
Middle Aged
Peristalsis
Radiography
Sincalide
Syndrome