Diagnosis and treatment of pseudoachalasia: how to catch the mimic

Barnett, Dylan; Balalis, George; Myers, Jennifer C.; Devitt, Peter G.

doi:10.21037/aoe.2020.03.03

Cited by 1 publication

(3 citation statements)

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“…The prevalence of pseudoachalasia varies between 1 and 5% of all diagnosed cases of AC. 7 The most common cause of pseudoachalasia is an underlying malignancy, most commonly a gastroesophageal junction malignancy (40%). 7 However, several benign causes such as amyloidosis and postsurgical alterations can lead to similar clinical and manometric findings.…”

Section: Identification Of Alternate Etiologies Mimicking Esophageal ...mentioning

confidence: 99%

“…7 The most common cause of pseudoachalasia is an underlying malignancy, most commonly a gastroesophageal junction malignancy (40%). 7 However, several benign causes such as amyloidosis and postsurgical alterations can lead to similar clinical and manometric findings. The hypothesis explaining the mechanism of such findings in pseudoachalasia is direct infiltration of the submucosal and muscular plexus by malignancy or paraneoplastic neuropathy arising as a result of distant malignancy.…”

Section: Identification Of Alternate Etiologies Mimicking Esophageal ...mentioning

confidence: 99%

“…The hypothesis explaining the mechanism of such findings in pseudoachalasia is direct infiltration of the submucosal and muscular plexus by malignancy or paraneoplastic neuropathy arising as a result of distant malignancy. 7 Clinical clues to a diagnosis of pseudoachalasia include an older age (>55 years), short duration of symptoms (<12 months), and weight loss of > 10 kg. 8 However, these clinical clues are not specific for pseudoachalasia.…”

Section: Identification Of Alternate Etiologies Mimicking Esophageal ...mentioning

confidence: 99%

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Esophageal Motility Disorders: Are We Missing in Our Busy Endoscopy Practice?

Elhence

Ghoshal

2021

Journal of Digestive Endoscopy

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Esophageal motility disorders (EMDs) form a significant part of a busy endoscopist's practice. Endoscopy plays an all-encompassing role in the diagnosis and management of EMDs including achalasia cardia. The focus on in-vogue third-space endoscopic procedures such as per-oral endoscopic myotomy often digresses the important role of endoscopy. Endoscopic evaluation forms the part of standard first-line evaluation of any dysphagia and serves to rule out a secondary cause such as an esophagogastric junction malignancy and eosinophilic esophagitis. Moreover, endoscopic evaluation may itself provide corroborative evidence that may contribute to the diagnosis of the motility disorder. Achalasia cardia may present with a wide spectrum of endoscopic findings from being entirely normal and the well-known and pathognomonic dilated sigmoid-shaped esophagus with food residue, to lesser-known ornate signs. The evidence on the role of endosonography in EMDs is conflicting and largely restricted to evaluation of pseudoachalasia. High-resolution manometry (HRM) remains the gold standard in the diagnosis of EMDs. Endoscopists must also keep abreast of the latest iteration of the Chicago classification version 4.0, which differs significantly from its predecessor in being more stringent in making diagnosis of esophagogastric junction outflow obstruction and disorders of peristalsis since these manometric findings may be seen in normal individuals and may be mimicked by opioid use and gastroesophageal reflux. The latest rendition also includes the use of provocative maneuvers and testing in both supine and sitting posture. Despite being the gold standard, there are certain lacunae in the use and interpretation of the Chicago classification of which the users should be well aware. Emerging technologies such as functional lumen imaging probe and planimetry, and timed barium esophagogram fill the lacuna in diagnosis of these motility disorders, which at times is beyond the resolution of HRM.

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Section: Identification Of Alternate Etiologies Mimicking Esophageal ...mentioning

confidence: 99%

Section: Identification Of Alternate Etiologies Mimicking Esophageal ...mentioning

confidence: 99%