217. IMPORTANCE OF PERFORMING BARIUM SWALLOW TEST FOR COLLECT DIAGNOSIS OF ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION INCLUDING ACHALASIA

Abstract

Abstract Background The clinical manifestation of achalasia is nonspecific (weight loss, vomiting); particularly, making an early diagnosis is often difficult. It often remains unrecognized for a long period or can be initially misdiagnosed as an eating disorder, such as anorexia nervosa, whose main clinical features mimic achalasia. Additionally, several overlooked patients with esophagogastric junction outflow obstruction (EGJOO), including achalasia, are should be identified in the community population. Methods 1. We collected data from 38 patients with achalasia and examined them for diagnostic factors that could lead to a delayed diagnosis. 2. The data of a cumulative total of 489,823 hospital visits at a tertiary medical center were collected. We selected patients with the given suspected diagnoses that could be misdiagnosed, and investigated the kind of imaging tests used in them. Among them, we selected patients with symptoms persisting for >6 months, without a definitive diagnosis, and in whom upper endoscopy, but not barium swallow test, was performed. Subsequently, we performed barium swallow tests in these patients. Results 1. The most important factor that caused a delay in the diagnosis of achalasia was non-performance of a chest CT scan or barium swallow test promptly at first physician contact. 2. We identified 39 people that could have been misdiagnosed, who had undergone upper endoscopy, but not barium swallow testing, with symptoms persisting for >6 months and without a definitive diagnosis. Among them, 16 individuals agreed to undergo the barium swallow test. One of them was confirmed to suffer from EGJOO. Conclusion To avoid a delayed diagnosis of EGJOO, including achalasia, performing a barium swallow test promptly, in addition to routine endoscopy, appears to be extremely important. Furthermore, we successfully identified one patient with EGJOO from among the community population using an extraction algorithm.