DIAGNOSIS AND PREDICTIVE FACTORS OF MALIGNANCIES ASSOCIATED PSEUDOACHALASIA: STILL A CLINICAL CHALLENGE

Aims:

A coherent distinction between primary and secondary achalasia is considerably important to physicians. This is because the treatment is entirely different. While pneumatic dilation is the gold standard for primary achalasia, it exposes to potential risk of complication and cause a diagnosis delay.

The aim of our study is to identify risk factors that suggest presence of malignancy associated to pseudo-achalasia.

Methods:

We conducted a retrospective study including all patients diagnosed with achalasia from 2006 to 2016. Diagnosis was based on manometric criteria. Pseudoachlasia was defined as a condition in which clinical and manometric signs of achalasia are mimicked by another abnormality, most often a malignancy.

Results:

Forty-two patients were included with a mean age of 40.3 years old (range 17 – 90 years). The sex ratio was 0.31 (10 male and 32 female). Malignant pseudoachalasia was diagnosed in three patients (7.1%): lung cancer, n = 1, adenocarcinoma of the gastric fundus, n = 1, gastroesophageal junction cancer, n = 1. Compared to patients with primary achalasia, pseudoachalasia occurred mainly in the elderly (mean age 38.2 years versus 67.8 years respectively, p = 0.001). Whereas the duration of symptoms before diagnosis was 7.6 moDInths with secondary achalasia, it was about 38 months with idiopathic achalasia, p = 0.002. In addition, the mean weight loss was significantly important if malignancy (9.2 kg versus 5.6 kg, p = 0.03).

Conclusions:

Our study showed that advanced age, important weight loss and short duration of symptoms are risk factors that suggest pseudoachalasia. In these cases, Computed tomography scan, is useful in discriminating pseudoachalasia from primary achalasia.