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pseudoachalasia
Etiology:
- tumor
- esp adenocarcinoma of gastroesophageal junction
- gastric cancer (involving cardia)
- esophageal cancer (distal esophagus)
- pancreatic cancer
- breast cancer
- direct tumor infiltration of paraneoplastic syndrome [3]
- lung cancer
- heptocellular carcinoma
- amyloidosis
- sarcoidosis
- surgery: Nissan fundoplication, bariatric surgery
Epidemiology:
- 10% of patients > 60 years of age presenting with symptoms suggestive of achalasia
Pathology:
1) invasion of the lower esophageal sphincter
2) encircling or compressing the distal esophagus
3) infiltrating the esophageal Auerbach plexus
Clinical manifestations:
- dysphagia to both solids & liquids
- chest pain, regurgitation [3]
- short duration of symptoms (months)
- weight loss
- symptoms mimic achalasia
Special laboratory:
1) endoscopy with biopsy
a) mucosal ulcerations or nodularity
b) grossly normal esophagus, stomach, & duodenum.
- may be normal because of submucosal involvement
c) elevated lower esophageal sphincter pressure & no normal peristalsis
- spastic contractions with swallowing
- may be difficult to pass the endoscope into the stomach
2) endoscopic ultrasound [2]
Radiology:
- CT of abdomen & thorax, looking closely at the gastroesophageal junction
Differential diagnosis:
- achalasia
Related
achalasia (cardiospasm)
General
esophageal disease
References
- UCLA Intensive Course in Geriatric Medicine & Board Review,
Marina Del Ray, CA, Sept 12-15, 2001
- Medical Knowledge Self Assessment Program (MKSAP) 15, 18.
American College of Physicians, Philadelphia 2009, 2018
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Ponds FA, van Raath MI, Mohamed SMM et al
Diagnostic features of malignancy-associated pseudoachalasia.
Aliment Pharmacol Ther. 2017 Jun;45(11):1449-1458.
PMID: 28382674