Case Of Pseudoachalasia Research Articles

Acute Onset Dysphagia: An Atypical Presentation of Idiopathic Achalasia

We are presenting a unique case of achalasia of primary idiopathic etiology mimicking Pseudoachalasia. A 50 Year old Hispanic female presented to our GI clinic with severe complains of dysphgaia to both solids and liquids and regurgitation for past 4 weeks. It has gotten worse over the past few days now associated nausea, vomiting and 15 pounds of weight loss. In her last three ER vists in the last 4 weeks, she was diagnosed as GERD and treated with PPI, Sucralfate and antiemetics. She denied any significant pertinent past medical and surgical history. Her vital signs and physical examination were unremarkable. She was admitted for the evalaution of worsening Dysphagia. Endoscopic Gastroduodenoscopy was done, which revealed moderately diffuse dilation of the body of the esophagus with semi solid food coating of the mucosa. The endoscope met mild resistance while crossing the gastroesophageal junction into the stomach. The CT Chest reported negative for intrathorasic masses, but displayed dilated and asymmetric mural thickening of esophagus. With gastric fundus adenocarcinoma and esophageal cancer ruled out on EGD and CT Chest and keeping in mind the atypical presentation of this achalasia; we ordered Endoscopic Ultrasonography-EUS to rule out intrathoracic or intraabdominal neoplasms in and around the lower esophageal sphincter. EUS rulled out Intraluminal or Extraluminal GE junctional masses or Paraesophageal lymphadenopathy. However non-appreciable esophageal motility and a hypertonic lower esophageal sphincter was observed. Our suspicion for idiopathic achalasia was thus enhanced, which was confirmed on Esophageal Motility study. She was reffered to Surgery for Heller's myotomy. It is well known that achalasia is a chronic disease that starts gradually and worsens with increasing dysphagia over time. On the contrary, Pseudoachalasia is a term used to define a malignant neoplasm or stricture arising from the lower esophagus or upper stomach invading the esophageal lumen or nerve plexus. Our patient at first glance was thought to be a case of pseudoachalasia (malignancy causing achalasia). However as evident by all our extensive investigations we were quite surprisingly dealing with Primary idiopathic achalasia with atypical acute onset.

偽性アカラシアを呈した胃癌術後下部食道壁内転移の1例

偽性アカラシアを呈した胃癌術後下部食道壁内転移の1例

Pseudoachalasia of the Esophagus Caused by Encapsulating Peritoneal Sclerosis

Encapsulating peritoneal sclerosis is a severe complication of peritoneal dialysis. Progressive sclerotic thickening of the peritoneum results in tethering and cocooning of the bowel, leading to chronic bowel obstruction, malabsorption, malnutrition, and high mortality. Conservative treatment is often unsuccessful and a surgical enterolysis is required for management. Pseudoachalasia is a rare condition that mimics the clinical and radiological features of achalasia of the cardia. Pseudoachalasia is most commonly caused by infiltrating or metastasizing cancers. In this report, we present a case of pseudoachalasia associated with encapsulating peritoneal sclerosis. The clinical symptoms settled after peritonectomy and enterolysis.

Pseudoachalasia: not only esophago-gastric cancer

Pseudoachalasia is a rare clinical entity which has clinical, radiographic and manometric features often indistinguishable from achalasia. A small primary adenocarcinoma arising at the gastroesophageal junction or a tumor of the distal esophagus are the most frequent causes. Rarely, processes other than esophagogastric cancers may lead to the development of pseudoachalasia. We present three cases of pseudoachalasia in which the primary cause of the disease was not an esophagogastric cancer. The causes were a pancreatic carcinoma, a breast cancer and an histiocytosis X. Aspects of these three patients' diagnostic and therapeutic course are discussed in detail.

Unusual upper gastrointestinal diseases associated with achalasia: laparoscopic approach

As a result of the high success rate associated with the laparoscopic approach for achalasia, surgery for the disease has become the treatment of choice in recent years. With the greater number of patients undergoing surgery, surgeons may encounter other upper gastroesophageal illnesses associated with achalasia, and these may require evaluation for simultaneous surgical treatment. This study aimed to evaluate the incidence of gastroesophageal diseases associated with achalasia, and to determine the possibility for simultaneous management using the laparoscopic approach. From January 1999 to May 2006, 81 patients were referred from the Service of Gastroenterology to the Service of General and Digestive Surgery as candidates for the surgical management of achalasia. Data for this group were recorded prospectively in laparoscopic surgery databases at the Hospital Sant Pau and the Hospital de Igualada. A total of 78 patients underwent laparoscopic Heller myotomy with gastric fundoplication. In 8 of 81 patients, nine additional gastroesophageal diseases (11.1%) were found: three cases of pseudoachalasia (3.7%), three cases of paraesophageal hiatal hernia (3.7%), two cases of esophageal diverticulum (2.5%), and one case of gastric volvulus (1.2%). Pseudoachalasia was diagnosed for three patients. The diagnosis was made preoperatively for one of these patients. For the other two patients, an adenocarcinoma arising from the gastroesophageal junction was diagnosed during the laparoscopy. In three cases, a paraesophageal hiatal hernia was found and treated by laparoscopic Heller myotomy, sac excision, hiatal closure, and posterior fundoplication. Esophageal diverticulectomy was performed for one patient. Another patient presented with an organoaxial gastric volvulus associated with achalasia, for which laparoscopic Heller myotomy, posterior fundoplication, and anterior gastropexy were performed. The median follow-up period was 39 months, with no recurrence. Despite their infrequency, several gastroesophageal diseases may be found in association with achalasia. Laparoscopic surgery may be useful for the diagnosis and/or treatment of both diseases.

Metastatic breast cancer to the gastrointestinal tract: A case series and review of the literature

Metastatic breast cancer involving the hepatobiliary tract or ascites secondary to peritoneal carcinomatosis has been well described. Luminal gastrointestinal tract involvement is less common and recognition of the range of possible presentations is important for early and accurate diagnosis and treatment. We report 6 patients with a variety of presentations of metastatic breast cancer of the luminal gastrointestinal tract. These include oropharyngeal and esophageal involvement presenting as dysphagia with one case of pseudoachalasia, a linitis plastica-like picture with gastric narrowing and thickened folds, small bowel obstruction and multiple strictures mimicking Crohn's disease, and a colonic neoplasm presenting with obstruction. Lobular carcinoma, representing only 10% of breast cancers is more likely to metastasize to the gastrointestinal tract. These patients presented with gastrointestinal manifestations after an average of 9.5 years and as long as 20 years from initial diagnosis of breast cancer. Given the increased survival of breast cancer patients with current therapeutic regimes, more unusual presentations of metastatic disease, including involvement of the gastrointestinal tract can be anticipated.