Esophageal achalasia secondary to gastric carcinoma. Report of a case and a review of the literature.

A case of invasive gastric carcinoma mimicking idiopathic achalasia radiologically, endoscopically and manometrically is described. This is only the second case of tumor-associated achalasia with a positive mecholyl test where there was no demonstrable histological tumor involvement of the myenteric plexus in the body of the esophagus. The interpretation of the manometric findings including the positive mecholyl test are discussed in the light of these histological findings. The short duration of symptoms, the presence of anemia and guaiac positive stools, along with subtle radiologic abnormalities of the gastric fundus were aspects of this case which should increase the index of suspicion and lead to the correct diagnosis. In the evaluation of patients with the achalasic syndrome, a tumor-associated functional and organic disorder mimicking idiopathic achalasia in all respects has to be considered.