Esophageai Achalasia: Still an Elusive Diagnosis

Abstract

One of the first esophageai motor disorders to be recognized and characterized, achalasia, still remains an elusive diagnosis. We have retrospectively reviewed our experience with achalasia patients sent to our motility laboratory for consultation. From January 1983 to June 1992 we evaluated 68 patients with previously untreated achalasia. Data were extracted from their file records. Presenting symptoms were dysphagia in 100% and food regurgitation in 71% of patients. Barium studies were abnormal in 82% of cases. An average of more than 4 years elapsed before symptom onset and referral to our laboratory to establish a correct diagnosis. It is concluded that achalasia is rarely suspected in common practice, and that the diagnostic delay is related to the scarce attention payed to the presenting symptoms, the misinterpretation of barium studies, and the late referral for manometric investigation.

Is It an Eating Disorder or Achalasia or Both? A Literature Review and Diagnostic Challenges

“…Several authors have argued that treatment delay is due to misinterpretation or misattribution of clinical findings, rather than an atypical presentation of the disease (Bassotti et al, ; Eckardt et al, ; Gockel et al, ; Richter, ; Rosenzweig & Traube, ). In this regard, we offer several clinical considerations based upon this review of the literature.…”

The Nutcracker Esophagus: A Late Diagnostic Yield Notwithstanding Chest Pain and Dysphagia

“…We expected that such patients would have an earlier diagnosis with respect to the other subgroups, since chest pain is an alarming symptom, taken much more seriously by patients and physicians than heartburn and dysphagia. In a previous study we have shown that in patients with achalasia, in whom dysphagia is the main symptom, the average diagnostic delay is 4 years [34].…”