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Latrache S, Melchior C, Desprez C, Sidali S, Recton J, Touchais O, van der Eecken E, Wuestenberghs F, Charpentier C, Leroi AM, Gourcerol G. Is it necessary to perform a morphological assessment for an esophageal motility disorder? A retrospective descriptive study. Clin Res Hepatol Gastroenterol 2021; 45:101633. [PMID: 33662774 DOI: 10.1016/j.clinre.2021.101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Esophageal motility disorders are most often of primary origin but may be secondary to an occult malignancy or another etiology. High-resolution esophageal manometry cannot differentiate between secondary or primary origin. This study aimed at discussing the usefulness of a morphological assessment in the diagnosis of specific esophageal motility disorders, and to establish the predictive factors of a potential secondary origin. METHODS In this retrospective study, patients with suspected esophageal motility disorders who underwent an esophageal manometry were included. High-resolution manometry results were interpreted according to the Chicago Classification, 3rd version. The results of endoscopic ultrasound and computed tomography, assessed by a panel of experts, allowed to diagnose a secondary origin. KEY RESULTS Out of 2138 patients undergoing manometry, 502 patients had a esophageal motility disorder suspect to be from secondary origin; among them 182 patients underwent tomography or endoscopic ultrasound. According to experts, 16 patients (8.8%) had a secondary esophageal motility disorder: esophagogastric junction outflow obstruction (n = 7), jackhammer disorder (n = 4), achalasia (n = 3) and localized pressurization (n = 2). The etiology was malignant in 8 patients. Predictive factors suggesting potential secondary esophageal motility disorders were smoking, age ≥ 58 years and an Integrated Relaxation Pressure higher than 10 mmHg for water swallows. CONCLUSION AND INFERENCES Esophageal motility disorders with organic origin are not uncommon. A morphological assessment using endoscopic ultrasonography and/or computed tomography may be of use to diagnose a secondary origin, especially in the elderly and smokers.
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Affiliation(s)
- Sofya Latrache
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Chloe Melchior
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Charlotte Desprez
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Sabrina Sidali
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Julien Recton
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Olivier Touchais
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Elise van der Eecken
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Fabien Wuestenberghs
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Cloe Charpentier
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Anne Marie Leroi
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France
| | - Guillaume Gourcerol
- ROUEN University Hospital - INSERM UMR 1073 / INSERM CIC-CRB 1404, 1 Rue de Germont, 76031 Rouen cedex, France.
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Schizas D, Theochari NA, Katsaros I, Mylonas KS, Triantafyllou T, Michalinos A, Kamberoglou D, Tsekrekos A, Rouvelas I. Pseudoachalasia: a systematic review of the literature. Esophagus 2020; 17:216-222. [PMID: 31989338 DOI: 10.1007/s10388-020-00720-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/20/2020] [Indexed: 02/03/2023]
Abstract
Pseudoachalasia, also known as secondary achalasia, is a clinical condition mimicking idiopathic achalasia but most commonly caused by malignant tumors of gastroesophageal junction (GEJ). Our aim was to systematically review and present all available data on demographics, clinical features, and diagnostic modalities involved in patients with pseudoachalasia. A systematic search of literature published during the period 1978-2019 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (end-of-search date: June 25th, 2019). Two independent reviewers extracted data with regards of study design, interventions, participants, and outcomes. Thirty-five studies met our inclusion criteria and were selected in the present review. Overall, 140 patients with pseudoachalasia were identified, of whom 83 were males. Mean patient age was 60.13 years and the mean weight loss was 13.91 kg. A total of 33 (23.6%) patients were wrongly 'treated' at first for achalasia. The most common presenting symptoms were dysphagia, food regurgitation, and weight loss. The median time from symptoms' onset to hospital admission was 5 months. Most common etiology was gastric cancer (19%). Diagnostic modalities included manometry, barium esophagram, endoscopy, and computed tomography (CT). Pseudoachalasia is a serious medical condition that is difficult to be distinguished from primary achalasia. Clinical feature assessment along with the correct interpretation of diagnostic tests is nowadays essential steps to differentiate pseudoachalasia from idiopathic achalasia.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 29 Parnithos, 16344, Ilioupolis, Athens, Greece
| | - Nikoletta A Theochari
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 29 Parnithos, 16344, Ilioupolis, Athens, Greece.
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 29 Parnithos, 16344, Ilioupolis, Athens, Greece
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 29 Parnithos, 16344, Ilioupolis, Athens, Greece
| | - Tania Triantafyllou
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | | | - Dimitrios Kamberoglou
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Andrianos Tsekrekos
- Division of Surgery, Department of Clinical Science Intervention and Technology, Department of Upper Abdominal Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Ioannis Rouvelas
- Division of Surgery, Department of Clinical Science Intervention and Technology, Department of Upper Abdominal Diseases, Karolinska Institutet, Stockholm, Sweden
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Gockel I, Eckardt VF, Schmitt T, Junginger T. Pseudoachalasia: a case series and analysis of the literature. Scand J Gastroenterol 2005; 40:378-85. [PMID: 16028431 DOI: 10.1080/00365520510012118] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pseudoachalasia frequently cannot be distinguished from idiopathic achalasia by manometry, radiologic examination or endoscopy. Mechanisms proposed to explain the clinical features of pseudoachalasia include a circumferential mechanical obstruction of the distal esophagus or a malignant infiltration of inhibitory neurons within the myenteric plexus. MATERIAL AND METHODS Between January 1980 and December 2002, the clinical features of 5 patients with pseudoachalasia and 174 patients with primary achalasia, diagnosed in a single center, were compared. A literature analysis of the etiology of pseudoachalasia for the time period 1968 to December 2002 was performed. The search concentrated on the databases and online catalogues PubMed, Web of Science, Cochrane Library and Current Contents Connect. RESULTS In our case series, patients with pseudoachalasia reported a shorter duration of symptoms and tended to be older than patients with primary achalasia. Conventional manometry, endoscopy and radiologic examination of the esophagus proved to be of little value in distinguishing between the diseases. In the majority of cases only surgical exploration revealed the underlying cause. A coincidence of primary achalasia and disorders of the gastroesophageal junction was excluded by showing return of peristalsis following treatment. The analysis of the literature showed a total of 264 cases of pseudoachalasia in 122 publications. Most cases of were due to malignant disease (53.9% primary and 14.9% secondary malignancy), followed by benign lesions (12.6%) and sequelae of surgical procedures at the distal esophagus or proximal stomach (11.9%). In rare instances, the disease was an expression of a paraneoplastic process due to distant neuronal involvement rather than to local invasion with destruction of the myenteric plexus (2.6%). CONCLUSIONS The diagnosis of pseudoachalasia is difficult to establish by conventional diagnostic measures. The main distinguishing feature of secondary versus primary achalasia is the complete reversal of pathologic motor phenomena following successful therapy of the underlying disorder.
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Affiliation(s)
- Ines Gockel
- Department of General and Abdominal Surgery, Johannes Gutenberg-University Mainz, Germany.
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Abstract
We report the case of a patient with a gastric remnant relapse of an antral carcinoma resected 5 years before and presenting with the clinical feature of a secondary achalasia (pseudoachalasia). In spite of the patient's 4-month history of dysphagia and weight loss that suggested a malignant lesion, barium swallow, repeated endoscopic biopsies and computed tomography (CT) scan of the upper abdomen did not reveal any abnormalities to indicate a recurrence. However, in the following months, because of worsening symptoms, a further CT scan was performed and revealed thickening of the cardia and gastric wall. The patient underwent an exploratory laparotomy that showed an unresectable lesion involving the gastric fundus, the diaphragm and penetrating into the mediastinum, and therefore a palliative jejunostomy was performed.
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Affiliation(s)
- C Iascone
- 1st Department of Surgery, Pietro Valdoni, Università La Sapienza, Policlinico Umberto I, Rome, Italy
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Moonka R, Patti MG, Feo CV, Arcerito M, De Pinto M, Horgan S, Pellegrini CA. Clinical presentation and evaluation of malignant pseudoachalasia. J Gastrointest Surg 1999; 3:456-61. [PMID: 10482700 DOI: 10.1016/s1091-255x(99)80097-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Malignant pseudoachalasia can be indistinguishable from primary achalasia on routine clinical evaluation, often resulting in a delay in diagnosis. To better define the clinical features and appropriate management of this disease, the course of five patients discovered to have pseudoachalasia after being referred for a minimally invasive Heller myotomy was reviewed, as were 67 cases of pseudoachalasia previously reported in the literature. Patients with an occult malignancy tended to present with shorter durations of symptoms, greater weight loss, and at a more advanced age than patients with primary achalasia. Since contrast radiography and endoscopy frequently failed to differentiate these two diseases, persons with presumed achalasia meeting these criteria who are referred for minimally invasive surgery should undergo additional imaging to rule out an occult malignancy, since this condition cannot be reliably detected during the course of a thoracoscopic or laparoscopic esophagomyotomy.
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Affiliation(s)
- R Moonka
- Department of Surgery, Seattle Veterans Affairs Medical Center and the University of Washington Medical Center, Seattle, WA, USA
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