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Modern insights into the pathophysiology and treatment of pseudoachalasia

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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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Data availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Rua Diogo de Faria 1087 Cj 301, São Paulo, 04037-003, Brazil

    Leonardo Yuri Kasputis Zanini & Fernando A. M. Herbella

  2. Department of Surgery, University of South Florida, Tampa, USA

    Vic Velanovich

  3. Department of Surgery, University of Virginia, Charlottesville, USA

    Marco G. Patti

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LYKZ: acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published. FAMH: conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published. VV: conception and design, review for intellectual content, and final approval of the version to be published. MGP: conception and design, review for intellectual content, and final approval of the version to be published.

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Zanini, L.Y.K., Herbella, F.A.M., Velanovich, V. et al. Modern insights into the pathophysiology and treatment of pseudoachalasia. Langenbecks Arch Surg 409, 65 (2024). https://doi.org/10.1007/s00423-024-03259-2

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