BACKGROUND: Pseudoachalasia is a condition in which clinical and manometric signs of achalasia are mimicked by another abnormality, most often a malignancy. AIM: To identify risk factors that suggest presence of malignancy-associated pseudoachalasia. METHODS: In this retrospective cohort study, achalasia patients newly diagnosed by manometry were included. Patients with a normal initial endoscopy, clinical and manometric signs of achalasia who were afterwards found to have an underlying malignant cause were classified as pseudoachalasia. Clinical and diagnostic findings were compared between malignant pseudoachalasia and achalasia. RESULTS: We included 333 achalasia patients [180 male, median age 50 (38-62)]. Malignant pseudoachalasia was diagnosed in 18 patients (5.4%). Patients with malignancy-associated pseudoachalasia were older at time of diagnosis [67 (54-71) vs. 49 (37-60) years], had a shorter duration of symptoms [6 (5-10) vs. 25 (11-60) months] and lost more weight [12 (9-17) vs. 5 (0-12) kg). In 61% of the pseudoachalasia patients, the oesophagogastric junction (OGJ) was difficult or impossible to pass during endoscopy, compared to 23% in achalasia. Age ≥55 years (OR 5.93), duration of symptoms ≤12 months (OR 14.5), weight loss ≥10 kg (OR 6.73) and difficulty passing the OGJ during endoscopy (OR 6.06) were associated with a higher risk of malignant pseudoachalasia. CONCLUSIONS: Advanced age, short duration of symptoms, considerable weight loss and difficulty in passing the OGJ during endoscopy, are risk factors that suggest potential malignancy-associated pseudoachalasia. To exclude pseudoachalasia, additional investigations are warranted when two or more risk factors are present.
BACKGROUND: Pseudoachalasia is a condition in which clinical and manometric signs of achalasia are mimicked by another abnormality, most often a malignancy. AIM: To identify risk factors that suggest presence of malignancy-associated pseudoachalasia. METHODS: In this retrospective cohort study, achalasiapatients newly diagnosed by manometry were included. Patients with a normal initial endoscopy, clinical and manometric signs of achalasia who were afterwards found to have an underlying malignant cause were classified as pseudoachalasia. Clinical and diagnostic findings were compared between malignant pseudoachalasia and achalasia. RESULTS: We included 333 achalasiapatients [180 male, median age 50 (38-62)]. Malignant pseudoachalasia was diagnosed in 18 patients (5.4%). Patients with malignancy-associated pseudoachalasia were older at time of diagnosis [67 (54-71) vs. 49 (37-60) years], had a shorter duration of symptoms [6 (5-10) vs. 25 (11-60) months] and lost more weight [12 (9-17) vs. 5 (0-12) kg). In 61% of the pseudoachalasia patients, the oesophagogastric junction (OGJ) was difficult or impossible to pass during endoscopy, compared to 23% in achalasia. Age ≥55 years (OR 5.93), duration of symptoms ≤12 months (OR 14.5), weight loss ≥10 kg (OR 6.73) and difficulty passing the OGJ during endoscopy (OR 6.06) were associated with a higher risk of malignant pseudoachalasia. CONCLUSIONS: Advanced age, short duration of symptoms, considerable weight loss and difficulty in passing the OGJ during endoscopy, are risk factors that suggest potential malignancy-associated pseudoachalasia. To exclude pseudoachalasia, additional investigations are warranted when two or more risk factors are present.
Authors: Afrin N Kamal; Priya Kathpalia; Fouad Otaki; Albert J Bredenoord; Donald O Castell; John O Clarke; Gary W Falk; Ronnie Fass; C Prakash Gyawali; Peter J Kahrilas; Philip O Katz; David A Katzka; John E Pandolfino; Roberto Penagini; Joel E Richter; Sabine Roman; Edoardo Savarino; George Triadafilopoulos; Michael F Vaezi; Marcelo F Vela; David A Leiman Journal: Neurogastroenterol Motil Date: 2021-03-15 Impact factor: 3.960
Authors: Kewin T H Siah; M Masudur Rahman; Andrew M L Ong; Alex Y S Soh; Yeong Yeh Lee; Yinglian Xiao; Sanjeev Sachdeva; Kee Wook Jung; Yen-Po Wang; Tadayuki Oshima; Tanisa Patcharatrakul; Ping-Huei Tseng; Omesh Goyal; Junxiong Pang; Christopher K C Lai; Jung Ho Park; Sanjiv Mahadeva; Yu Kyung Cho; Justin C Y Wu; Uday C Ghoshal; Hiroto Miwa Journal: J Neurogastroenterol Motil Date: 2020-07-30 Impact factor: 4.924
Authors: R A B Oude Nijhuis; G Zaninotto; S Roman; G E Boeckxstaens; P Fockens; M W Langendam; A A Plumb; Ajpm Smout; E M Targarona; A S Trukhmanov; Blam Weusten; Albert J Bredenoord Journal: United European Gastroenterol J Date: 2020-02 Impact factor: 4.623