Pseudoachalasia: A review

Abstract

Pseudoachalasia presents typically like achalasia. It account for only 2.4-4% of patients presenting with achalasia-like symptoms. Clinical, radiologic and endoscopic findings resemble those of achalasia but treatment and prognosis are different in these conditions. The aim of this review is to give an overview of the condition and highlight challenges in diagnosis and distinguishing features between the two conditions. A review of the publications obtained from Medline search, medical libraries, and Google on 'pseudoachalasia' and 'secondary achalasia' was done. A total of 50 articles were retrieved and used for this review. There has been tremendous efforts towards establishing the diagnosis of pseudoachalasia both clinically and with the use of modern investigative modalities but to date its still difficult to distinguish it from achalasia. Endoscopy, endoscopic ultrasonography and computerized tomography scan have shown promising results.

2019 Seoul Consensus on Esophageal Achalasia Guidelines

“…When biopsy is negative but secondary achalasia is suspected, computed tomography or endoscopic ultrasonography can help to rule out pseudoachalasia. 38,39 In idiopathic achalasia, the endoscopic findings at the EGJ range from normal-appearing (in about 40% of patients) to a thickened muscular ring that may have a rosette configuration on retroflexion, accompanied by signs of esophagitis such as friability, thickening, and even erosion secondary to food stasis (Fig. 5), as well as mild-to-moderate resistance to intubation of the EGJ.…”

Pseudoachalasia secondary to metastatic bladder cancer

“…Pseudoachalasia is a rare disease accounting for a small subgroup of patients with dysphagia. Most cases are associated with primary neoplasia at the GE junction, with greater than 50% of these cases being adenocarcinoma 6–8. Other primary malignancies reported include pancreatic, hepatocellular, prostatic, lung, mesothelioma, and lymphoma 5 10.…”

“…This results in proximal oesophageal dilation or secondary impairment of the inhibitory neurons of the oesophageal myenteric plexus. A secondary mechanism, that is much rarer, is a paraneoplastic syndrome with antineuronal nuclear antibodies involving the interaction of tumour factors with the oesophageal neuronal plexus without direct infiltration of the GE junction 6–8…”

“…Therefore, it necessitates early consideration and a timely diagnosis. Pseudoachalasia is generally found in older-aged patients (>60 years), with acute onset of dysphagia (<1 year), rapid progression of symptoms, and significant weight loss 1 5–9. Most cases of pseudoachalasia due to malignancy are from a gastrointestinal (GI) primary.…”

Present insight on achalasia – from diagnosis to treatment

“…Opposite to idiopathic achalasia, pseudoachalasia occurs due to a secondary condition in which achalasialike symptoms mimic another abnormality. This accounts for only 2.4-5.4% of patients with clinical and manometric signs of achalasia and tends to occur in the elderly [30].…”