Abstract
Background and Study AimsEndoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia.Patients and MethodsThis single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, “pinstripe pattern (PSP)” was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding.ResultsThe prevalence rates of the above-mentioned findings (1–5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity. Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change. The accuracy, sensitivity, and specificity for achalasia were 83.8%, 64.7%, and 100%, respectively.Conclusion“Pinstripe pattern” could be a reliable indicator for early discrimination of primary esophageal achalasia.
Highlights
Esophageal achalasia is a rare benign esophageal motility disease (1/100000) due to impaired relaxation of the lower esophageal sphincter (LES) resulting from nerve damage [1]
The present study shows that the early diagnosis of esophageal achalasia can be very difficult without most typical findings such as extensive esophageal dilatation and massive food remnant in the esophagus
Because achalasia commonly occurs in relatively young females, these patients are sometimes misdiagnosed with psychological disorders including anorexia nervosa without proper medical assessment and examination
Summary
Esophageal achalasia is a rare benign esophageal motility disease (1/100000) due to impaired relaxation of the lower esophageal sphincter (LES) resulting from nerve damage [1]. Associate complications include pulmonary complications from chronic food aspiration and esophageal carcinoma. 71 cases of esophageal achalasia that includes 56 patients with no previous treatment referred to our hospital. Seventeen of all 56 cases took longer than 10 years to be diagnosed as an esophageal achalasia. Some patients were not diagnosed properly even after multiple sessions of endoscopic examination. Endoscopic features including substantial dilatation with tortuosity or large amount of food remnant are listed in the characteristic indicators for achalasia. These findings are visible as its radiological manifestations and generally occur with advancement of the condition. Achalasia patients in earlier stage do not necessarily have such typical macroscopic features.
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