The diagnosis and misdiagnosis of achalasia. A study of 25 consecutive patients.

An impression that achalasia remains an elusive diagnosis led us to review our recent experience. From August 1, 1985 to March 31, 1987, we saw 25 patients with "previously untreated" achalasia for consultation and/or treatment. Data was extracted from review of their records. Achalasia was the initial diagnosis in only 12 patients. The others were given diagnoses of gastroesophageal reflux (4), presbyesophagus (2), esophageal spasm (2), psychiatric disorders (2), and combination of various disorders (3). In the latter patients, various diagnostic studies were either inappropriately delayed or misinterpreted, so that incorrect diagnoses were given. Errors in diagnosis led to further inappropriate testing and therapies. We conclude that: (a) achalasia remains an elusive diagnosis in current practice, (b) errors in diagnosis are related to delay in obtaining appropriate studies or misinterpretation of such studies, and (c) this delay leads to persistent symptoms and ineffective and/or inappropriate therapies.