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https://hdl.handle.net/2440/135677
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Type: | Journal article |
Title: | Diagnosis and treatment of pseudoachalasia: how to catch the mimic |
Author: | Barnett, D.R. Balalis, G.L. Myers, J.C. Devitt, P.G. |
Citation: | Annals of Esophagus, 2020; 3:16-1-16-16 |
Publisher: | AME Publishing Company |
Issue Date: | 2020 |
ISSN: | 2616-2784 |
Statement of Responsibility: | Dylan R. Barnett, George L. Balalis, Jennifer C. Myers, Peter G. Devitt |
Abstract: | Pseudoachalasia, or secondary achalasia, is an uncommon esophageal dysmotility syndrome with symptoms and manometric findings indistinguishable from primary achalasia, but due to any mechanism other than idiopathic degeneration of the inhibitory neurons of the esophageal submucosal myenteric plexus. Whilst pseudoachalasia is rare, affecting some 1.4–5.4% of all achalasia patients, it is essential this diagnosis is always considered and excluded, as the treatment and outcomes for these patients will be very different from those with true achalasia. Pseudoachalasia can be difficult to differentiate from primary or “idiopathic achalasia”. Several particular clinical features have been described as more common in patients with pseudoachalasia than in achalasia, but because of the low prevalence of this condition, the positive predictive value remains low. The majority of patients with pseudoachalasia have an underlying malignancy, predominantly gastro-esophageal adenocarcinoma, which is usually advanced. Management revolves around treating the underlying cause where possible, as this may lead to reversal of the esophageal dysmotility. In patients presenting with symptoms and manometry findings consistent with achalasia, the diagnosis initially should be one of an achalasia-like syndrome. Idiopathic achalasia can then only be confirmed after other potential causes have been considered and excluded. We describe a case of pseudoachalasia encountered in our clinical practice, followed by a review of current practice regarding diagnosis and management of pseudoachalasia. |
Keywords: | Esophageal motility disorders; pseudoachalasia; dysphagia; secondary achalasia |
Description: | Published: 25 June 2020 |
Rights: | © Annals of Esophagus. All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/. |
DOI: | 10.21037/aoe.2020.03.03 |
Published version: | http://dx.doi.org/10.21037/aoe.2020.03.03 |
Appears in Collections: | Aurora harvest 4 Surgery publications |
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hdl_135677.pdf | Published version | 685.06 kB | Adobe PDF | View/Open |
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