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Pseudoachalasia: a systematic review of the literature

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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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Author notes

  1. Dimitrios Schizas and Nikoletta A. Theochari have equally contributed as first authors.

Authors and Affiliations

  1. First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 29 Parnithos, 16344, Ilioupolis, Athens, Greece

    Dimitrios Schizas, Nikoletta A. Theochari, Ioannis Katsaros & Konstantinos S. Mylonas

  2. First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece

    Tania Triantafyllou

  3. Department of Anatomy, European University of Cyprus, Nicosia, Cyprus

    Adamantios Michalinos

  4. Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece

    Dimitrios Kamberoglou

  5. Division of Surgery, Department of Clinical Science Intervention and Technology, Department of Upper Abdominal Diseases, Karolinska Institutet, Stockholm, Sweden

    Andrianos Tsekrekos & Ioannis Rouvelas

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  1. Dimitrios Schizas
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Correspondence to Nikoletta A. Theochari.

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Schizas, D., Theochari, N.A., Katsaros, I. et al. Pseudoachalasia: a systematic review of the literature. Esophagus 17, 216–222 (2020). https://doi.org/10.1007/s10388-020-00720-1

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