Pseudoacasalia: um desafio diagnóstico / Pseudoachalasia: a diagnostic challenge

Pseudoacalasia se manifesta de forma semelhante à acalasia do esfíncter esofágico inferior (EEI). Corresponde a 2,4 a 4% dos casos que simulam acalasia 1 . Estima-se que cerca de 50% dos casos de pseudoacalasia correspondam a malignidade primária do esôfago e da junção gastroesofágica e 18% a malignidades secundárias como doença metastática 1,2 . Etiologias benignas também estão descritas. No presente trabalho apresentamos um caso de pseudoacalasia com ênfase nos aspectos radiológicos. Revisamos também aspectos clínicos e radiológicos que podem auxiliar no diagnóstico diferencial entre acalasia e pseudoacalasia. (AU)

Pseudoachalasia is a condition that mimics idiopathic achalasia of the lower esophageal sphincter. It accounts for 2.4 to 4% of patients presenting with achalasia-like symptoms. It is estimated that about 50% of cases of pseudoachalasia correspond to primary malignancies of the esophagus and the esophagogastric junction and 18% to secondary malignancies such as metastases 1,2 . Benign causes are also described. In this report we emphasize radiological findings of a case of pseudoachalasia. We also review clinical and radiological aspects that might be auxiliary in the differential diagnosis between achalasia and pseudoachalasia. (AU)

Achalasia secondary to lung adenocarcinoma

No abstract available.

Extragastroesophageal Malignancy-Associated Secondary Achalasia: A Rare Association of Pancreatic Cancer Rendering Alarm Manifestation

Secondary achalasia or pseudoachalasia is a rare esophageal motor abnormality, which mimics primary achalasia; it is not easily distinguishable from idiopathic achalasia by manometry, radiological examination, or endoscopy. Although the majority of reported pseudoachalasia cases are associated with neoplasms at or near the esophagogastric (EG) junction, other neoplastic processes or even chronic illnesses such as rheumatoid arthritis can lead to the development of pseudoachalasia, for example, mediastinal masses, gastrointestinal (GI) tumors of the liver and biliary tract, and non-GI malignancies. Therefore, even if a patient presents with the typical findings of achalasia, we should be alert to the possibility of other GI malignancies besides EG tumors. For instance, pancreatic cancer was found in the case reported here; only four such cases have been reported in the literature. A 47-year-old man was admitted to our center with a 3-month history of dysphagia. His endoscopic and esophageal manometric findings were compatible with primary achalasia. However, unresponsiveness to diverse conventional achalasia treatments led us to suspect secondary achalasia. An active search led to a diagnosis of pancreatic mucinous cystadenocarcinoma invading the gastric fundus and EG junction. This rare case of pseudoachalasia caused by pancreatic carcinoma emphasizes the need for suspecting GI malignancies other than EG tumors in patients refractory to conventional achalasia treatment.

Radiología en Acalasia y Pseudoacalasia / Radiology in Achalasia and Pseudoachalasia

Propósito: Revisar hallazgos clínicos (edad y duración de la disfagia) y radiológicos (dilatación esofágica y longitud de la estrechez) para diferenciar acalasia primaria de pseudoacalasia maligna. Material y métodos: Se analizaron historias clínicas de un periodo comprendido entre abril de 1997 y abril de 2007 (10 años) en pacientes con diagnóstico confirmado de acalasia o pseudoacalasia. Criterios de inclusión: acalasia primaria: ausencia de peristaltismo primario y falla en relajación del esfínter esofágico inferior; pseudoacalasia: ausencia de peristaltismo primario y estenosis del tercio inferior esofágico. Las variables clínicas estudiadas fueron: edad, sexo, duración de la disfagia y presencia o ausencia de enfermedad de Chagas. Las variables radiológicas se obtuvieron de estudios baritados, determinando longitud de la estrechez y diámetro esofágico máximo. El análisis estadístico de las variables se realizó con test T de student. Resultados: Se incluyeron en el estudio 64 pacientes: 55 portadores de acalasia primaria, uno de acalasia secundaria (enfermedad de Chagas) y ocho de pseudoacalasia: seis malignas: tres carcinomas de esófago, dos de techo gástrico y una metástasis de cáncer pulmonar; y dos etiologías benignas: una estenosis péptica y una leiomiomatosis. Las variables que mostraron diferencias significativas fueron: la edad del grupo con acalasia primaria fue 56 ± 16 años y los de pseudoacalasia maligna 68 ± 8 años con una p <0,01. La duración de la disfagia en acalasia primaria fue 40 ± 50 meses, y en pseudoacalasia maligna fue 11, 33 ± 6,74 meses, p<0,001. La longitud de la estenosis para acalasia primaria fue 2,17 ± 0,63 cm, y para pseudoacalasia maligna 3,91 ± 1,56, p<0,05. Por último, el diámetro esofágico máximo en acalasia primaria fue 5,40 ±1,67 cm y para pseudoacalasia maligna 3,66 ± 0,81, p<0,001. Conclusión: La acalasia primaria fue más frecuente en pacientes menores de 55 años, con una disfagia de más de un año de duración. El diámetro máximo del esófago fue mayor de 4 cm y la longitud del segmento estrecho menor de 2 cm. La pseudoacalasia maligna fue más frecuente en pacientes mayores de 65 años, la duración de la disfagia fue menor de 1 año. El diámetro máximo del esófago fue inferior a 4 cm y la longitud del segmento estrecho superior a 2 cm.

Objective: To review clinical (age, dysphagia duration) and radiological findings (esophagus dilatation, stenosis length) in order to differentiate primary achalasia from malignant pseudoachalasia. Material and methods: Clinical records in patients with confirmed diagnosis of achalasia or pseudoachalasia from April 1997 to April 2007 (ten years) were analyzed. Criteria of inclusion: primary achalasia: absence of primary peristalsis and failure in relaxation of the lower esophageal sphincter; pseudoachalasia: absence of primary peristalsis and narrowed lower esophageal segment. The clinical variables studied were: age, sex, duration of dysphagia and presence or absence of Chagas disease. The radiological variables were obtained from barium studies, determining stenosis length and maximum esophagus diameter. The statistical analysis of the variables was made with test T of student. Results: 64 patients, 55 of primary achalasia, eight of pseudoachalasia and one of secondary achalasia were included for the study. Malignant pseudoachalasia: three esophageal carcinomas, two carcinomas of the cardias and one metastasis of pulmonary cancer. Benign etiology: one peptic stenosis and one leiomyomatosis. One patient with Chagas disease was considered secondary achalasia. The clinical variables that showed significant differences were: The age, that in the primary achalasia group was 56 ± 16 years and in malignant pseudoachalasia group was 68 ± 8 years with p <0,01 (significant). The duration of dysphagia in primary achalasia was 40 ±50 months, and in malignant pseudoachalasia was 11, 33± 6.74 months, p<0,001 (significant). The stenosis length for primary achalasia was 2,17 ± 0,63 cm, and for malignant pseudoachalasia 3,91 ± 1,56, p<0,05 (significant). Finally the maximum esophagus diameter in primary achalasia group was 5,40 ± 1,67 cm and for malignant pseudoachalasia 3,66± 0,81 p<0.001 (significant). Conclusion: Primary achalasia is more frequent in patients younger than 55 years with lasting of dysphagia of more than one year. The maximum esophagus diameter is over 4 cm and the stenosis length shorter than 2 cm. Malignant pseudoachalasia is more frequent in older patients of 65 years, with the duration of dysphagia less of 1 year. The maximum esophagus diameter is under 4 cm and the length of the narrowed segment is greater to 2 cm.

A Case of Pseudoachalasia Following Reflux-Induced Stricture of the Esophagus / 대한소화관운동학회지

Pseudoachalasia is a distinct clinical entity that mimics idiopathic achalasia. However, the pathophysiology of pseudoachalasia is debated. Although neoplastic involvement of the distal esophagus is the most common cause of pseudoachalasia, benign disease of the distal esophagus could result in clinical entity of pseudoachalasia as well. We report a case of pseudoachalasia following a benign esophageal stricture by gastroesophageal reflux disease, which needs to differentiate from malignant esophageal strictures.