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Zanini LYK, Herbella FAM, Velanovich V, Patti MG. Modern insights into the pathophysiology and treatment of pseudoachalasia. Langenbecks Arch Surg 2024; 409:65. [PMID: 38367052 DOI: 10.1007/s00423-024-03259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Secondary achalasia or pseudoachalasia is a clinical presentation undistinguishable from achalasia in terms of symptoms, manometric, and radiographic findings, but associated with different and identifiable underlying causes. METHODS A literature review was conducted on the PubMed database restricting results to the English language. Key terms used were "achalasia-like" with 63 results, "secondary achalasia" with 69 results, and "pseudoachalasia" with 141 results. References of the retrieved papers were also manually reviewed. RESULTS Etiology, diagnosis, and treatment were reviewed. CONCLUSIONS Pseudoachalasia is a rare disease. Most available evidence regarding this condition is based on case reports or small retrospective series. There are different causes but all culminating in outflow obstruction. Clinical presentation and image and functional tests overlap with primary achalasia or are inaccurate, thus the identification of secondary achalasia can be delayed. Inadequate diagnosis leads to futile therapies and could worsen prognosis, especially in neoplastic disease. Routine screening is not justifiable; good clinical judgment still remains the best tool. Therapy should be aimed at etiology. Even though Heller's myotomy brings the best results in non-malignant cases, good clinical judgment still remains the best tool as well.
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Affiliation(s)
- Leonardo Yuri Kasputis Zanini
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Rua Diogo de Faria 1087 Cj 301, São Paulo, 04037-003, Brazil
| | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Rua Diogo de Faria 1087 Cj 301, São Paulo, 04037-003, Brazil.
| | - Vic Velanovich
- Department of Surgery, University of South Florida, Tampa, USA
| | - Marco G Patti
- Department of Surgery, University of Virginia, Charlottesville, USA
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César-Freitas KG, Berardis ACP, Pretto TVM, Viagi AM, Lourençon V, Zanini LYK, Barbosa ICC, Machado RP, Cunha NGM, Watanabe MJL, Cecchini MA, Brucki SMD, Nitrini R. Follow-up of participants with subjective cognitive decline from Tremembé epidemiologic study, Brazil. Dement Neuropsychol 2023; 17:e20220064. [PMID: 37261255 PMCID: PMC10229081 DOI: 10.1590/1980-5764-dn-2022-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/07/2023] [Accepted: 03/09/2023] [Indexed: 06/02/2023] Open
Abstract
Subjective cognitive decline is defined as a self-perceived cognitive decline but with normal performance in neuropsychological assessments. Objective To verify the evolution of patients diagnosed with subjective cognitive decline compared to the cognitively normal group without any concern. Methods This is a follow-up study based on data analysis from the Tremembé epidemiologic study, in Brazil. The 211 individuals classified as cognitively normal and 174 diagnosed as having subjective cognitive decline at baseline were invited to participate. Results After a median follow-up time of five years, 108 subjective cognitive decline participants (62.0%) were reassessed. Of these, 58 (53.7%) kept this diagnosis, whereas 14 individuals (12.9%) progressed to mild cognitive impairment and 5 (4.6%) to dementia. In the cognitively normal group, 107 (50.7%) were reassessed, of which 51 (47.7%) were still classified likewise, 6 (5.6%) evolved to mild cognitive impairment and 9 (8.4%) to dementia. The presence of cognitive decline had a significant association with increasing age and depression symptoms. Considering the total number of baseline participants in each group: the subjective cognitive decline group showed higher percentage of mild cognitive impairment (p=0.022) and no difference was found in progression to dementia (p=0.468) between the groups after follow-up assessment. Conclusion Most subjective cognitive decline participants at baseline kept their cognitive complaint at follow-up and this group progressed more to mild cognitive impairment than the other group. No difference in the progression to dementia was found, despite the higher incidence of dementia in the cognitively normal group.
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Affiliation(s)
- Karolina Gouveia César-Freitas
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Neurologia Cognitiva e Comportamental, Departamento de Neurologia, São Paulo SP, Brazil
- Universidade de Taubaté, Departamento de Medicina, Taubaté SP, Brazil
| | | | | | | | - Vitorio Lourençon
- Universidade de Taubaté, Departamento de Medicina, Taubaté SP, Brazil
| | | | | | | | | | | | - Mario Amore Cecchini
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Neurologia Cognitiva e Comportamental, Departamento de Neurologia, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Neurologia Cognitiva e Comportamental, Departamento de Neurologia, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Neurologia Cognitiva e Comportamental, Departamento de Neurologia, São Paulo SP, Brazil
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