Pseudoachalasia secondary to bariatric surgery

Ravi, Karthik; Sweetser, Seth; Katzka, David A.

doi:10.1111/dote.12422

Cited by 22 publications

(11 citation statements)

References 13 publications

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“…Achalasia is predominantly an idiopathic disease secondary to a selective loss of inhibitory neurons of the myenteric plexus, most likely due to an autoimmune phenomenon in response to unknown antigens 14 . Similar clinical presentation, however, can occur in patients with pseudoachalasia (5% of patients with suspected achalasia) due to malignant obstruction 4 or operations 20 at the esophagogastric junction. Achalasia can also be secondary to a tropical disease called Chagas´ disease, characterized by degeneration of the myenteric plexus due to Trypanosoma infection 6 .…”

Section: Introductionmentioning

confidence: 83%

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Neto

Herbella

Schlottmann³

et al. 2018

ABCD, arq. bras. cir. dig.

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Introduction: The diagnosis of achalasia may be suggested by clinical features but a complete work-up is required not only to confirm the diagnosis but also to grade the disease by severity or clinical subtype. Objective: To review the current evaluation of esophageal achalasia and its correct comprehension. Method: The literature review was based on papers published on Medline/Pubmed, SciELO and Lilacs, crossing the following headings: “esophageal achalasia”; “deglutition disorders”; “diagnostic techniques”, “digestive system”; “endoscopy, digestive system”; “manometry”. Results: The diagnosis of achalasia is suggested by clinical features but is not sufficient to distinguish this from other esophageal disease. It must be confirmed by further diagnostic tests, such as esophagogastroduodenoscopy, barium swallow and manometry. Recent advances in diagnostic methods, including high resolution manometry might even help predicting outcome or selected more appropriate procedures to treat the disease. Conclusion: A detailed and systematic study of achalasia patients allows not only a correct diagnosis but also contributes to therapeutic decision making and prognosis.

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Section: Introductionmentioning

confidence: 83%

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Neto

Herbella

Schlottmann³

et al. 2018

ABCD, arq. bras. cir. dig.

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“…A large spectrum of underlying causes has been reported, including thoracic aortic aneurysm [30], rheumatoid arthritis [31], previous Nissen fundoplication [32], bariatric surgery and adjustable gastric band placement [33,34], amyloidosis [35,36], sarcoidosis [37], systemic mastocytosis [38], intestinal pseudoobstruction [39], and Chagas disease [40]. In Fabry disease, the accumulation of lysosomal Gb₃ (globotriaosylceramide) leads to neuronal and vascular dysfunction that may also cause pseudoachalasia [41].…”

Section: Discussionmentioning

confidence: 99%

Pseudoachalasia as First Manifestation of a Malignancy

Fabian¹,

Eherer

Lackner

et al. 2019

Dig Dis

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Pseudoachalasia is a condition in which symptoms, radiologic, endoscopic, and manometric findings mimick idiopathic achalasia. About 4% of patients with a typical constellation for idiopathic achalasia will turn out to have pseudoachalasia, posing a major diagnostic challenge. A large spectrum of underlying causes of pseudoachalasia has been described. However, in about 70% of affected patients, this condition is caused by a malignancy (mostly adenocarcinoma of the esophagogastric junction or cardia). We describe a 16-year-old high school student referred for management of achalasia who turned out to have pseudoachalasia due to adenocarcinoma of the cardia. He was cured with preoperative chemotherapy followed by radical surgery. Therapy of pseudoachalasia secondary to neoplasia is directed against the tumor or may be palliative to keep the lumen open. Other causes of pseudoachalasia include esophageal motility disturbances as a paraneoplastic phenomenon (e.g., with small cell lung cancer), post fundoplication or post bariatric surgery, in association with a thoracic aortic aneurysm, or with sarcoidosis or amyloidosis. Therapy is directed accordingly to eliminate or correct the underlying cause.

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“…In most cases, pseudoachalasia results from malignancy (68.8%), mainly gastric fundus adenocarcinoma and squamous cell carcinoma of the distal oesophagus. Less frequently, it is due to benign lesions, vascular obstruction or as a consequence of previous surgical procedures, such as Nissen fundoplication or bariatric surgery [31]. Oesophageal motility disturbances may be an effect of paraneoplastic phenomenon (e.g.…”

Section: Introductionmentioning

confidence: 99%

Present insight on achalasia – from diagnosis to treatment

Dziedzic

Nowak

Zgodziński

et al. 2019

J Pre Clin Clin Res.

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Introduction. Achalasia is a most frequent primary motility disorder of the oesophagus with the prevalence of 10/100,000 individuals, with no gender predominance. Due to its rare occurrence, at the early stages may be erroneously diagnosed, leading to progression of disease and delayed treatment. Objectives. The main aim of the review is to depict current data about achalasia, including pathogenesis, diagnosis, and possible treatment modalities, particularly the latest, minimally invasive technique: per-oral endoscopic myotomy (POEM). State of knowledge. The ethology of achalasia remains unknown, although autoimmune, viral or neurodegenerative causes may be considered triggers of the disease. In some cases, achalasia may be secondary to other conditions (e.g. malignancy, Chagas disease). Typical symptoms of achalasia are dysphagia (for both liquids and solids), regurgitations, heartburn and weight loss. The diagnosis is based on endoscopy, oesophageal high-resolution manometry (HRM) and X-ray with barium swallow. Therapies used in the treatment of achalasia focus on improving food passage by reducing LES pressure. These procedures include pharmacologic treatment, pneumatic balloon dilation, Heller myotomy and endoscopic myotomy. POEM was first introduced in humans by Inoue in 2008. Recent studies have revealed excellent short-term outcome of POEM with no serious complications. Conclusion. Achalasia is an incurable disease; however, available therapies can effectively reduce patients` symptoms. Further evaluation may lead to the establishment of tailored-to-patient treatment, and it is believed that POEM will become a gold standard for treatment of achalasia.

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Pseudoachalasia secondary to bariatric surgery

Cited by 22 publications

References 13 publications

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Pseudoachalasia as First Manifestation of a Malignancy

Present insight on achalasia – from diagnosis to treatment

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