pseudoachalasia

Etiology

• tumor
  • esp adenocarcinoma of gastroesophageal junction
    • gastric cancer (involving cardia)
    • esophageal cancer (distal esophagus)
  • pancreatic cancer
  • breast cancer
  • 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

• invasion of the lower esophageal sphincter
• encircling or compressing the distal esophagus
• infiltrating the esophageal Auerbach plexus

Clinical manifestations

• short duration of symptoms (months)
• weight loss

Diagnostic procedures

• endoscopy with biopsy
  • mucosal ulcerations or nodularity
  • may be normal because of submucosal involvement
  • may show incomplete lower esophageal relaxation &/or absence of peristalsis
  • inability to pass the endoscope into the stomach
• endoscopic ultrasound

Radiology

• CT of abdomen & thorax, looking closely at the gastroesophageal junction

Differential diagnosis

• achalasia

More general terms

• esophageal disease

Additional terms

• achalasia (cardiospasm)