Pseudoachalasia: not only esophago-gastric cancer

Abstract

Pseudoachalasia is a rare clinical entity which has clinical, radiographic and manometric features often indistinguishable from achalasia. A small primary adenocarcinoma arising at the gastroesophageal junction or a tumor of the distal esophagus are the most frequent causes. Rarely, processes other than esophagogastric cancers may lead to the development of pseudoachalasia. We present three cases of pseudoachalasia in which the primary cause of the disease was not an esophagogastric cancer. The causes were a pancreatic carcinoma, a breast cancer and an histiocytosis X. Aspects of these three patients' diagnostic and therapeutic course are discussed in detail.

Pseudoachalasia Secondary to Metastatic Breast Carcinoma

“…A review of these path reports revealed that there were two cases of infiltrating lobular carcinoma, two cases of infiltrating ductal carcinoma, and one case of breast carcinoma with histopathology not specified by the authors [8,[12][13][14]. Therefore, this report describes only the third confirmed case of pseudoachalasia secondary to metastatic infiltrating ductal carcinoma.…”

A rare case of multiple myeloma initially presenting with pseudoachalasia

“…Pseudoachalasia is a rare clinical entity with clinical, radiographic, and manometric features often indistinguishable from achalasia 1–4 . Esophageal manometry, the key test to establish the diagnosis, usually demonstrates findings similar to achalasia including raised LES pressure, abnormal LES relaxation, and in the majority of patients, absent or incomplete relaxation with wet swallows 1 .…”

“…Primary adenocarcinomas arising at the gastroesophageal junction or a tumor of the distal esophagus are the most frequent causes of pseudoachalasia. Rarely, processes other than esophagogastric cancers including chronic idiopathic intestinal pseudo‐obstruction, amyloidosis, sarcoidosis, Chagas' disease, vagotomy, antireflux surgery, pancreatic pseudocysts, von Recklinghausen's neuroinomatosis, gastrointestinal stromal tumor, and other malignancies and rare genetic syndromes, may lead to the development of pseudoachalasia 4,6,7 . Approximately 2–4% of patients suspected of achalasia suffer from pseudoachalasia 2,4 and establishing the diagnosis can be difficult.…”

“…Rarely, processes other than esophagogastric cancers including chronic idiopathic intestinal pseudo‐obstruction, amyloidosis, sarcoidosis, Chagas' disease, vagotomy, antireflux surgery, pancreatic pseudocysts, von Recklinghausen's neuroinomatosis, gastrointestinal stromal tumor, and other malignancies and rare genetic syndromes, may lead to the development of pseudoachalasia 4,6,7 . Approximately 2–4% of patients suspected of achalasia suffer from pseudoachalasia 2,4 and establishing the diagnosis can be difficult. Specifically, previous reports suggest that one‐third of patients who have pseudoachalasia because of cancer will suffer a delay in diagnosis because of the occult nature of these malignancies.…”

Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

“…Several reports have considered pseudoachalasia as a secondary form of achalasia showing that these patients, in contrast to those with idiopathic achalasia, are more likely to be older (>60 years), with short duration of symptoms (<1 year), and presenting with substantial weight loss [2–6]. It mimics idiopathic achalasia because of the same manometric findings, that is, loss of peristalsis in the oesophageal body and lack of relaxation of the LES [7–11].…”