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Pseudoachalasia: Still a Tough Clinical Challenge.

Jia Y, McCallum RW - Am J Case Rep (2015)

Bottom Line: Further investigations finally uncovered esophageal adenocarcinoma, thus making our patient an example of the entity "pseudoachalasia".Pseudoachalasia secondary to an esophageal malignancy should be suspected when dysphagia progresses despite technically well-performed pneumatic dilations, and is particularly suspicious in the setting of an elderly patient with marked weight loss.Endoscopic ultrasound is a new diagnostic tool for detecting and staging malignancy by obtaining diagnostic tissue and allowing appropriate therapy to be planned.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.

ABSTRACT

Background: Treatment of achalasia is focused on decreasing the resting lower esophageal sphincter by either pneumatic dilation or surgical myotomy. When patients symptomatically relapse after one or more pneumatic dilations, then one explanation is to consider the possibility of pseudoachalasia as the diagnosis.

Case report: We present a rare case of an elderly patient with a presentation of chronic dysphagia and severe weight loss, who had diagnostic findings consistent with achalasia, and who also responded very well to a series of pneumatic dilations, but for only brief intervals. Further investigations finally uncovered esophageal adenocarcinoma, thus making our patient an example of the entity "pseudoachalasia".

Conclusions: Pseudoachalasia secondary to an esophageal malignancy should be suspected when dysphagia progresses despite technically well-performed pneumatic dilations, and is particularly suspicious in the setting of an elderly patient with marked weight loss. Endoscopic ultrasound is a new diagnostic tool for detecting and staging malignancy by obtaining diagnostic tissue and allowing appropriate therapy to be planned.

No MeSH data available.


Related in: MedlinePlus

A motility study can distinguish achalasia from other motility disorders. The presence of aperistalsis in the distal two-thirds of the esophagus and incomplete LES relaxation on esophageal manometry, defined as a mean four-second integrated relaxation pressure (IRP) >15 mmHg are the manometric criteria required for the achalasia. Our patient’s outpatient high-resolution manometry results indicated a Type 2 classification.
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f1-amjcaserep-16-768: A motility study can distinguish achalasia from other motility disorders. The presence of aperistalsis in the distal two-thirds of the esophagus and incomplete LES relaxation on esophageal manometry, defined as a mean four-second integrated relaxation pressure (IRP) >15 mmHg are the manometric criteria required for the achalasia. Our patient’s outpatient high-resolution manometry results indicated a Type 2 classification.

Mentions: Patient underwent a high resolution esophageal motility study which showed a classic achalasia pattern with resting LES pressure of 36 mmHg (normal 10–40 mmHg), integrated relaxation pressure (IRP) >15 mmHg, inadequate (25%) relaxation of the LES with wet swallows; aperistalsis with wet swallows with low amplitude contractions (<30 mmHg), consistent with type 2 Chicago classification for achalasia (Figure 1). The upper esophageal sphincter and striated muscle function were intact. Esophagogastroduodenoscopy (EGD) found patchy candidiasis in the lower third of the esophagus and a dilated, atonic esophagus. A hypertonic lower esophageal sphincter was found with resistance to endoscopic passage into the stomach. The Z-line was irregular and located 37 cm from the incisors with a 3 cm hiatus hernia.


Pseudoachalasia: Still a Tough Clinical Challenge.

Jia Y, McCallum RW - Am J Case Rep (2015)

A motility study can distinguish achalasia from other motility disorders. The presence of aperistalsis in the distal two-thirds of the esophagus and incomplete LES relaxation on esophageal manometry, defined as a mean four-second integrated relaxation pressure (IRP) >15 mmHg are the manometric criteria required for the achalasia. Our patient’s outpatient high-resolution manometry results indicated a Type 2 classification.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4630955&req=5

f1-amjcaserep-16-768: A motility study can distinguish achalasia from other motility disorders. The presence of aperistalsis in the distal two-thirds of the esophagus and incomplete LES relaxation on esophageal manometry, defined as a mean four-second integrated relaxation pressure (IRP) >15 mmHg are the manometric criteria required for the achalasia. Our patient’s outpatient high-resolution manometry results indicated a Type 2 classification.
Mentions: Patient underwent a high resolution esophageal motility study which showed a classic achalasia pattern with resting LES pressure of 36 mmHg (normal 10–40 mmHg), integrated relaxation pressure (IRP) >15 mmHg, inadequate (25%) relaxation of the LES with wet swallows; aperistalsis with wet swallows with low amplitude contractions (<30 mmHg), consistent with type 2 Chicago classification for achalasia (Figure 1). The upper esophageal sphincter and striated muscle function were intact. Esophagogastroduodenoscopy (EGD) found patchy candidiasis in the lower third of the esophagus and a dilated, atonic esophagus. A hypertonic lower esophageal sphincter was found with resistance to endoscopic passage into the stomach. The Z-line was irregular and located 37 cm from the incisors with a 3 cm hiatus hernia.

Bottom Line: Further investigations finally uncovered esophageal adenocarcinoma, thus making our patient an example of the entity "pseudoachalasia".Pseudoachalasia secondary to an esophageal malignancy should be suspected when dysphagia progresses despite technically well-performed pneumatic dilations, and is particularly suspicious in the setting of an elderly patient with marked weight loss.Endoscopic ultrasound is a new diagnostic tool for detecting and staging malignancy by obtaining diagnostic tissue and allowing appropriate therapy to be planned.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.

ABSTRACT

Background: Treatment of achalasia is focused on decreasing the resting lower esophageal sphincter by either pneumatic dilation or surgical myotomy. When patients symptomatically relapse after one or more pneumatic dilations, then one explanation is to consider the possibility of pseudoachalasia as the diagnosis.

Case report: We present a rare case of an elderly patient with a presentation of chronic dysphagia and severe weight loss, who had diagnostic findings consistent with achalasia, and who also responded very well to a series of pneumatic dilations, but for only brief intervals. Further investigations finally uncovered esophageal adenocarcinoma, thus making our patient an example of the entity "pseudoachalasia".

Conclusions: Pseudoachalasia secondary to an esophageal malignancy should be suspected when dysphagia progresses despite technically well-performed pneumatic dilations, and is particularly suspicious in the setting of an elderly patient with marked weight loss. Endoscopic ultrasound is a new diagnostic tool for detecting and staging malignancy by obtaining diagnostic tissue and allowing appropriate therapy to be planned.

No MeSH data available.


Related in: MedlinePlus