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

Abstract

Introduction: Achalasia is a rare oesophageal motility disorder characterized by physical, behavioural and psychosocial features that are strikingly similar to eating disorders (ED). Method: A literature search of PubMed and Google Scholar identified 36 cases of achalasia from 11 countries misdiagnosed as ED between 1980 and 2013. Results: On average, the typical misdiagnosed case was an 18-year-old female with an average weight loss of 16.2 kg. Vomiting behaviour in achalasia was distinguished by occurring after both solids and liquids, occurring in public, and worsening at night or while lying down, and was associated with pain relief. Manometric investigations of oesophageal functioning in clinical ED samples are few and have shown little evidence of dysmotility. Discussion: Achalasia and ED share numerous clinical features including weight loss and vomiting. Pain associated with swallowing difficulties may lead to an increasingly restricted pattern of eating and food avoidance. Increased awareness of achalasia in ED treatment settings can help facilitate detection of achalasia, thereby reducing treatment delay.

Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample

“…Regarding physical symptomatology in ARFID, common clinical signs are failure to thrive, gastroesophageal reflux, constipation, nausea, early satiety, abdominal pain, and global developmental delay (Cooney et al, 2018; Eddy et al, 2015). Particularly for AN, ARFID and other restrictive eating disorders, specific nutritional deficiencies, such as the lack of vitamin C, B1, B6, B9, B12, D or protein‐calorie malnutrition and frequent vomiting can cause inflammation, atrophy of the GI system, and immune dysfunction, resulting in medical complications in the digestive system (Benezech, Hartmann, Morfin, Bertrand, & Domenech, 2020; Bern & O'Brien, 2013; Bern, Woods, & Rodriguez, 2016; Hadley & Walsh, 2003; Johansson, Norring, Unell, & Johansson, 2012; Lelli et al, 2014; Reas, Zipfel, & Rø, 2014; Tomita et al, 2014). Thereby, restrictive eating disorders can be confused with GI diseases—suggesting that the diagnosis of ARFID is easily overlooked and the specific clinical consequences can be missed (Bern & O'Brien, 2013).…”

“…malnutrition and frequent vomiting can cause inflammation, atrophy of the GI system, and immune dysfunction, resulting in medical complications in the digestive system (Benezech, Hartmann, Morfin, Bertrand, & Domenech, 2020;Bern & O'Brien, 2013;Bern, Woods, & Rodriguez, 2016;Hadley & Walsh, 2003;Johansson, Norring, Unell, & Johansson, 2012;Lelli et al, 2014;Reas, Zipfel, & Rø, 2014;Tomita et al, 2014). Thereby, restrictive eating disorders can be confused with GI diseases-suggesting that the diagnosis of ARFID is easily overlooked and the specific clinical consequences can be missed (Bern & O'Brien, 2013).…”

Achalasia cardia presenting with bilateral broncheactasis in a child

“…Children with achalasia suffering from recurrent vomiting and regurgitation may be mistaken for eating disorders, and at times both can coexist. 6 Achalasia patients may eat slow or adopt abnormal posturing to facilitate deglutition. Our patient adapted to eat slowly.…”

Importance of Barium Swallow Test and Chest CT Scan for Correct Diagnosis of Achalasia in the Primary Care Setting

“…Sex or racial difference in the incidence rate of the disease has not been known. Because the chief complaints in achalasia are nonspecific (e.g., weight loss, vomiting, and persistent cough), this disease has many differential diagnoses, such as anorexia nervosa, gastroesophageal reflux disease, psychosomatic disease, and cardiovascular ischemic disease (Bennett 2001;Desseilles et al 2006;Badillo and Francis 2014;Reas et al 2014;Jeon et al 2017). As a result, if not recognized in the early phase, the diagnosis of achalasia is often delayed (Gockel et al 2012).…”