Idiopathic achalasia mistakenly diagnosed as anorexia nervosa

Abstract

In the case reported here, the absence of intention to lose weight and body-image distortion was initially neglected. Depressive symptoms, personality traits, familial relationship and ambivalence on the perspective of nutritional recovery were overestimated at the expense of clinical history and vomiting characteristics, leading to the initial misdiagnosis.We thus conclude that, when assessing patients with a hypothetical ED, psychopathological symptoms must always be carefully evaluated. The exclusion of organic etiology must be a priority, even when the need of psychiatric and psychotherapeutic interventions is evident. In suspected AN cases without selfinduced vomiting, idiopathic achalasia must always be excluded before the final diagnosis.

Pregnancy delusion hinders the diagnosis of achalasia in a patient with life-threatening emaciation

“…Association between achalasia and psychiatric symptoms is not rare: indeed, achalasia is a differential diagnosis to anorexia nervosa. There have also been reports that these conditions can occur simultaneously [ 1 , 3 – 5 ]. In such cases, the initial diagnosis of anorexia nervosa may mask and delay the diagnosis of achalasia, potentially leading to worse clinical outcomes.…”