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Review Article

Pseudoachalasia: a diagnostic challenge. When to consider and how to manage?

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Pages 747-752 | Received 19 Mar 2021, Accepted 29 Apr 2021, Published online: 27 May 2021
 

Abstract

Pseudoachalasia accounts for up to 4% of patients who present with achalasia-like picture and most often relates to occult malignancy at the cardia or gastroesophageal junction. Thus, any delay in diagnosis might lead to more advanced disease and less chance for curative therapy, not to mention the risk of serious complications resulting from the treatment of supposed achalasia instead of the true underlying cause. The entity should be suspected in patients with advanced age of onset, a shorter duration of symptoms, profound weight loss and difficulty in passing the gastroesophageal junction on endoscopy. The diagnosis of pseudoachalasia can be challenging as upper endoscopy with biopsy might be false negative in 25% of cases and lesions cannot always be detected on computerized tomography scan. Endoscopic ultrasound and guided biopsy play an increasingly important role in the workup of this condition. Treatment of pseudoachalasia depends on the underlying cause. The aim of this review is to highlight the clinicopathological features that distinguish pseudoachalasia from achalasia and the most appropriate diagnostic workup as well as the subsequent management for this condition.

Ethical approval

This article does not contain any studies with human or animal subjects performed by any of the authors. Ethical approval and informed consent are not required.

Disclaimer

The authors confirm that they have permission from ‘John Wiley and Sons’ to reproduce the figures used in the article.

Disclosure statement

The authors declare that they have no conflict of interest.

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