Achalasia leading to diagnosis of adenocarcinoma of the oesophagus

Abstract

A 50-year-old male with a 7 month history of progressive dysphagia to solids then subsequently to liquids. He underwent a diagnostic gastroscopy which was normal. A further barium swallow suggested achalasia. He was referred to a tertiary centre, where he underwent pH and manometry studies which confirmed a diagnosis of achalasia. He was referred for a laparoscopic cardiomyotomy, and at surgery there was a suspected tumour at the gastro-oesophageal junction. A follow-up endoscopy with biopsies was normal. Following this, a positron emission tomography scan showed T3 distal oesophageal cancer with no nodal involvement or distal metastasis. An attempt at oesophagectomy was performed, but at operation there was locally advanced carcinoma infiltrating the coeliac axis. He is currently undergoing palliative chemotherapy.

First Reported Case of Femoral Facial Syndrome in an Adult: Esophageal Adenocarcinoma as a Progressive Gastrointestinal Manifestation

“…Concerningly, EAC is usually detected at an advanced stage when symptoms manifest [ 17 ]. Early diagnosis is the most effective method of improving survival in patients with EAC [ 15 ], such as recognizing patients at high risk for BE and performing a proper endoscopic evaluation to monitor progression in patients displaying BE [ 15 , 18 ].…”

Cancer Risk in Patients With Achalasia

“…32,33 While most cases of esophageal cancer associated with achalasia are SCC, EAC has been found in this population, however, majority of these cases occur after achalasia treatment, presumably as a result of iatrogenic reflux, with case reports describing EAC in the pre-treatment setting. 34,35 Abnormal esophageal acid exposure may be present among patients with untreated achalasia and there is data to suggest that transient lower esophageal sphincter relaxations may still occur in the setting, which in combination with impaired esophageal clearance may explain the development of BE among both treated and untreated achalasia patients. 11,12,36 As previously discussed, among achalasia patients increased stasis of food may potentially lead to bacterial overgrowth and fermentation within the esophagus, ultimately leading to chronic inflammation and neoplastic transformation through DNA damage through N-nitrosocompounds, lipopolysaccharide and lactic acid, which may also contribute to lower esophageal pH or LES relaxation ultimately leading to Barrett's esophagus.…”

“…32,33 While most cases of esophageal cancer associated with achalasia are SCC, EAC has been found in this population, however, majority of these cases occur after achalasia treatment, presumably as a result of iatrogenic reflux, with case reports describing EAC in the pre-treatment setting. 34,35 Abnormal esophageal acid exposure may be present among patients with untreated achalasia and there is data to suggest that transient lower esophageal sphincter relaxations may still occur in the setting, which in combination with impaired esophageal clearance may explain the development of BE among both treated and untreated achalasia patients. 11,12,36…”

Is it necessary to perform a morphological assessment for an esophageal motility disorder? A retrospective descriptive study

“…The common form is primary EMD. Secondary forms are less common and have been little studied [7,8]. At yet, pseudoachalasia or "secondary achalasia" is the most studied secondary EMD.…”