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Journal ArticleDOI

Achalasia may mimic anorexia nervosa, compulsive eating disorder, and obesity problems.

01 May 2006-Psychosomatics (United States)-Vol. 47, Iss: 3, pp 270-271

TL;DR: The case of a young man referred for evaluation of anorexia nervosa, who, after investigation, turned out to be suffering from achalasia, is reported.

AbstractTO THE EDITOR: In the past, physicians did exhaustive medical evaluation in the pursuit of organic pathology for patients with eating disorders. Judging from the literature, the incidence of anorexia nervosa increased over the past century until the 1970s, and now, physicians have an increased awareness of it and find it easier to diagnose. The consequence is the increasing failure to notice organic pathology in patients who have a history of eating disorders. We report the case of a young man referred for evaluation of anorexia nervosa, who, after investigation, turned out to be suffering from achalasia.

Summary (1 min read)

Achalasia May Mimic Anorexia Nervosa, Compulsive Eating Disorder, and Obesity Problems

  • In the past, physicians did exhaustive medical evaluation in the pursuit of organic pathology for patients with eating disorders.
  • 1 Judging from the literature, the incidence of anorexia nervosa increased over the past century until the 1970s, 2 and now, physicians have an increased awareness of it and find it easier to diagnose.
  • The consequence is the increasing failure to notice organic pathology in patients who have a history of eating disorders.
  • The authors report the case of a young man referred for evaluation of anorexia nervosa, who, after investigation, turned out to be suffering from achalasia.

Case Report

  • Mr. A, a 24-year-old Caucasian patient, had a history of vomiting and a 60-kg weight loss over the preceding 7 months (Body Mass Index [BMI] at admission: 17.6).
  • Frequently, the parents would force him to eat and wait with him during some time after meals to make sure that he did not vomit, because the boy had uncontrollable vomiting after every meal.
  • The patient stated that he often had chest pain after food or liquid intake.
  • Body-image distortions were absent, but the intention to lose weight was present at the early stage.
  • She was currently receiving psychotherapy for depression.

Discussion

  • Dysphagia is the initial and main clinical feature of achalasia.
  • 4 During this period, achalasia can be mistaken for anorexia nervosa.
  • Patients with eating disorders frequently have gastric emptying abnormalities causing bloating, postprandial fullness, and vomiting.
  • These symptoms usually improve with refeeding, but sometimes promotility agents may be necessary.
  • They differentiate between two groups of symptoms: first, dysphagia, odynophagia, heartburn, and reflux have esophageal origins and occur in achalasia.

Postconcussional Symptoms Not a Syndrome

  • Taber's Cyclopedic Medical Dictionary defines syndrome as "a group of symptoms, signs, laboratory findings, and physiological disturbances that are linked by a common anatomical, biochemical, or pathological history.", also known as TO THE EDITOR.
  • It is my view that symptoms typically attributed to post-concussion are so nonspecific and are associated with such a wide variety of other conditions that they do not meet the definition of a syndrome.
  • The injury claimants had no history of brain injury or toxic exposure.
  • 5 McAllister and Arciniegas 6 pointed out that the term "post-concussive syndrome" is used inconsistently in the literature, that the symptoms have high base rates in the general population, and that they are nonspecific in nature.
  • It is unfortunate that Dr. Hall and colleagues have not referenced these controversies in their otherwise excellent review article.

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Letters
270 http://psy.psychiatryonline.org Psychosomatics 47:3, May-June 2006
tention to the possible benefits of anti-
convulsants and dopamine-antagonists.
Carol A. Couts, M.D.
Ondria C. Gleason, M.D.
Dept. of Psychiatry, Univ. of
Oklahoma College of Medicine,
Tulsa, OK
References
1. Kasim K, Jinnah HA: Self-biting induced
by activation of L-type calcium channels
in mice: dopaminergic influences. Dev
Neurosci 2003; 25:20–25
2. Carroll J, Schaffer C, Splensley J, et al:
Family experiences of self-mutilating
patients. Am J Psychiatry 1980; 137:852–
853
Achalasia May Mimic
Anorexia Nervosa,
Compulsive Eating Disorder,
and Obesity Problems
T
OTHE
E
DITOR
: In the past, physicians
did exhaustive medical evaluation in
the pursuit of organic pathology for pa-
tients with eating disorders.
1
Judging
from the literature, the incidence of an-
orexia nervosa increased over the past
century until the 1970s,
2
and now, phy-
sicians have an increased awareness of
it and find it easier to diagnose. The
consequence is the increasing failure to
notice organic pathology in patients
who have a history of eating disorders.
3
We report the case of a young man re-
ferred for evaluation of anorexia ner-
vosa, who, after investigation, turned
out to be suffering from achalasia.
Case Report
Mr. A, a 24-year-old Caucasian patient,
had a history of vomiting and a 60-kg
weight loss over the preceding 7
months (Body Mass Index [BMI] at ad-
mission: 17.6). He had suffered from
asthma since his childhood. When he
was 18, his weight was 96 kg, and he
described, from the age of 18 to age 23,
compulsive eating behavior with bing-
ing, but not purging, and use of laxa-
tives or diuretics. Six months before the
beginning of symptoms mimicking an-
orexia nervosa, his best friend had died
in an automobile accident. At this time,
he was 120 kg (BMI: 37). He is still
very affected by this accident.
When he was admitted, his clinical
evaluation was normal except for a low
potassium level (2.7 mmol/liter) and
frequent complaints about “a lump in
the throat.” His parents believed that he
practiced self-induced vomiting, al-
though he denied this. Frequently, the
parents would force him to eat and wait
with him during some time after meals
to make sure that he did not vomit, be-
cause the boy had uncontrollable vom-
iting after every meal. The early symp-
toms were heartburn and dysphagia.
The patient stated that he often had
chest pain after food or liquid intake.
Body-image distortions were absent,
but the intention to lose weight was
present at the early stage. He denied
self-induced vomiting, but did note that
vomiting improved his symptoms and
that he was preoccupied by food, with-
out any rituals. The patient did not use
laxatives or diuretics.
Family history revealed that the
mother had been diagnosed as having
morbid obesity and had had bariatric
surgery. She was currently receiving
psychotherapy for depression.
For his general practitioner, the
conflict about food and autonomy be-
tween Mr. A and his parents was
thought to have contributed to the ill-
ness.
An upper gastrointestinal radio-
graphic series revealed a grossly di-
lated esophagus and a tight esophageal
sphincter compatible with the diagno-
sis of achalasia. Pneumatic dilatation of
the lower esophageal sphincter was
successful, and the patient has gained
weight since that time. He is still under
psychotherapeutic treatment for his
family and behavioral problems.
Discussion
Dysphagia is the initial and main clini-
cal feature of achalasia. Often, several
years elapse before the disease is
diagnosed, and, during this time, other
symptoms, such as vomiting and
weight loss, are common.
4
During this
period, achalasia can be mistaken for
anorexia nervosa. Moreover, previous
obesity of the patient is of interest,
since an association between morbid
obesity and achalasia has been de-
scribed.
5
This, along with episodes of
asthma,
6
leads us to believe that the pa-
tient probably had his achalasia before
his symptoms of dysphagia.
Nevertheless, differential diagno-
sis between achalasia and anorexia ner-
vosa is not always obvious. First, it has
been reported that esophageal motor
disorders are common in patients with
a diagnosis of primary anorexia ner-
vosa.
7
For example, patients with eat-
ing disorders frequently have gastric
emptying abnormalities causing bloat-
ing, postprandial fullness, and vomit-
ing. These symptoms usually improve
with refeeding, but sometimes promo-
tility agents may be necessary.
8
Sec-
ond, willful avoidance of food and
spontaneous or self-induced vomiting
have been reported in patients with
achalasia.
9–11
Thus, gastrointestinal
disorders are common in eating-disor-
der patients, and many gastrointestinal
diseases sometimes present like eating
disorders. But, for Rosenzweig and
Traube,
12
errors in diagnosis are related
to delay in obtaining appropriate inves-
tigations or misinterpretation of their
results. Abell and Werkman
13
suggest
that a careful clinical history can local-
ize gastrointestinal motility disorders,

Letters
Psychosomatics 47:3, May-June 2006 271
and they suggest appropriate diagnostic
tests.
13
They differentiate between two
groups of symptoms: first, dysphagia,
odynophagia, heartburn, and reflux
have esophageal origins and occur in
achalasia. The appropriate diagnostic
tests in this case are barium-swallow
endoscopy
10
and esophageal motility
studies (esophageal manometry or scin-
tigraphy). The second group of symp-
toms includes nausea, vomiting, an-
orexia, bloating, and abdominal pain,
which are symptoms of motor disorders
of the stomach and small intestine.
In summary, the exclusion of or-
ganic disease must be a priority, even if
a psychotherapeutic intervention may
be needed in the global care of this
group of patients.
Martin Desseilles
Sonia Fuchs
Marc Ansseau
Dept. of Psychiatry, Univ. of Lie`ge,
Belgium
Sandra Lopez
Elena Vinckenbosh
Antonio Andreoli
Dept. of Psychiatry, Univ. of Geneva,
Switzerland
References
1.
Wright K, Smith MS, Mitchell J: Organic
diseases mimicking atypical eating
disorders. Clin Pediatr 1990; 29:325–328
2.
Hoek HW, van Hoeken D: Review of the
prevalence and incidence of eating
disorders. Int J Eat Disord 2003; 34:383–
396
3.
McSherry J: Oesophageal achalasia
mistaken for anorexia nervosa (abstract).
BMJ 1992; 305:583
4.
Duane PD, Magee TM, Alexander MS, et
al: Oesophageal achalasia in adolescent
women mistaken for anorexia nervosa
(abstract). BMJ 1992; 305:43
5.
Almogy G, Anthone GJ, Crookes PF:
Achalasia in the context of morbid
obesity: a rare but important association.
Obes Surg 2003; 13:896–900
6.
Schiller LR: Upper gastrointestinal
motility disorders and respiratory
symptoms. Am J Health Syst Pharm
1996; 53:S13–S16
7.
Stacher G, Kiss A, Wiesnagrotzki S, et
al: Oesophageal and gastric motility
disorders in patients categorised as
having primary anorexia nervosa. Gut
1986; 27:1120–1126
8. McClain CJ, Humphries LL, Hill KK, et
al: Gastrointestinal and nutritional aspects
of eating disorders. J Am Coll Nutr 1993;
12:466–474
9. Stacher G, Wiesnagrotzki S, Kiss A:
Symptoms of achalasia in young women
mistaken as indicating primary anorexia
nervosa. Dysphagia 1990; 5:216–219
10. Prior AJ: Oesophageal achalasia mistaken
for anorexia nervosa. BMJ 1992; 305:
833–834
11. Kenney RD: Achalasia in an adolescent
with behavioral features compatible with
anorexia nervosa. J Adolesc Health Care
1984; 5:283–285
12. Rosenzweig S, Traube M: The diagnosis
and misdiagnosis of achalasia: a study
of 25 consecutive patients. J Clin
Gastroenterol 1989; 11:147–153
13. Abell TL, Werkman RF: Gastrointestinal
motility disorders. Am Fam Physician
1996; 53:895–902
Postconcussional Symptoms
Not a Syndrome
T
OTHE
E
DITOR
: Tabers Cyclopedic
Medical Dictionary defines syndrome
as “a group of symptoms, signs, labo-
ratory findings, and physiological dis-
turbances that are linked by a common
anatomical, biochemical, or pathologi-
cal history.” It is my view that symp-
toms typically attributed to post-con-
cussion are so nonspecific and are
associated with such a wide variety of
other conditions that they do not meet
the definition of a syndrome. Iverson
and McCracken
1
showed that postcon-
cussive-like symptoms are not unique
to the sequelae of mild traumatic brain
injury and can also be seen in condi-
tions of chronic pain. Gouvier et al.
2
compared undergraduate students and
their families with a group of head-in-
jury patients. They concluded that there
were “no significant differences found
between the brain-damaged individuals
and normals on items assessing self-
reported memory problems, problems
becoming interested in things, frequent
loss of temper, irritability, fatigue, or
impatience.”
2
Lees-Haley et al.
3
compared 50
control subjects against 170 personal-
injury claimants. The injury claimants
had no history of brain injury or toxic
exposure. In spite of this, they reported
very high rates of complaints generally
associated with the so-called “post-
concussion syndrome.”
Chan
4
studied base rates of symp-
toms in patients who had not suffered
a head injury. The study showed that a
high proportion of participants reported
symptoms similar to those with so-
called post-concussion syndromes.
Rees
5
opined that “published ob-
servational work on the nature and eti-
ology of “persistent post-concussive
syndrome” and, more particularly, its
cognitive sequelae, have been charac-
terized by an unfortunate lack of data,
errors in sampling, and insecure meth-
odology.”
5
McAllister and Arciniegas
6
pointed
out that the term “post-concussive syn-
drome” is used inconsistently in the lit-
erature, that the symptoms have high
base rates in the general population, and
that they are nonspecific in nature.
In summary, the so-called symp-
toms of post-concussional syndrome
are notable in that: 1) they are present
in a significant number of the normal
population, and 2) they are present in
very significant numbers of patients
who have suffered trauma not involv-
ing concussion or brain injury.
Therefore, I conclude there is in-
adequate evidence that these symptoms
meet the definition of a “syndrome.”
It is unfortunate that Dr. Hall and
colleagues have not referenced these
controversies in their otherwise excel-
lent review article.
7
Derryck H. Smith, M.D., FRCP(C)
Clinical Professor, University of
British Columbia, Medical
Citations
More filters

Journal ArticleDOI
TL;DR: Patients with eating disorders present with various gastrointestinal disturbances such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, with altered esophageal motility sometimes seen in patients with anorexia nervosa.
Abstract: The two most clinically serious eating disorders are anorexia nervosa and bulimia nervosa. A drive for thinness and fear of fatness lead patients with anorexia nervosa either to restrict their food intake or binge-eat then purge (through self-induced vomiting and/or laxative abuse) to reduce their body weight to much less than the normal range. A drive for thinness leads patients with bulimia nervosa to binge-eat then purge but fail to reduce their body weight. Patients with eating disorders present with various gastrointestinal disturbances such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, with altered esophageal motility sometimes seen in patients with anorexia nervosa. Other common conditions noted in patients with eating disorders are postprandial distress syndrome, superior mesenteric artery syndrome, irritable bowel syndrome, and functional constipation. Binge eating may cause acute gastric dilatation and gastric perforation, while self-induced vomiting can lead to dental caries, salivary gland enlargement, gastroesophageal reflux disease, and electrolyte imbalance. Laxative abuse can cause dehydration and electrolyte imbalance. Vomiting and/or laxative abuse can cause hypokalemia, which carries a risk of fatal arrhythmia. Careful assessment and intensive treatment of patients with eating disorders is needed because gastrointestinal symptoms/disorders can progress to a critical condition.

71 citations


Journal ArticleDOI
TL;DR: The objective was to report the increased awareness of eating disorders and that it is likewise important to recognize that organic pathology (achalasia) can cause symptoms that may mimic an eating disorder and lead to misdiagnosis.
Abstract: Eating disorders are commonly considered diagnoses in young women who present with unexplained weight loss and vomiting. Our objective was to report the increased awareness of eating disorders and that it is likewise important to recognize that organic pathology (achalasia) can cause symptoms that may mimic an eating disorder and lead to misdiagnosis. Two case reports are presented and a review of the existing literature is provided. In the first patient, initial diagnosis of nonclassified eating disorder based on a pubertal conflict was made, and 3.5 years later diagnosis of primary achalasia was established. Atypical bulimia nervosa was initially suspected in the other case, but diagnosis of achalasia was established at an early stage of evaluation. The exclusion of organic disease must be a priority, even if a psychotherapeutic intervention may be needed in the global care of eating disorder patients. Esophageal achalasia should be considered in anyone presenting with difficulty swallowing or dysphagia, even if other features suggest anorexia nervosa or bulimia nervosa.

19 citations


Journal ArticleDOI
TL;DR: The issues of gastrointestinal symptoms and complications in the course of Anorexia nervosa, and the rules of nutritional therapy are approached.
Abstract: Anorexia nervosa (AN) is the third most common disorder, after obesity and asthma, in the population of adolescents between 13-18 years of age. Food intake reduction is associated with whole body dysfunction, affecting its physical, psychological and social spheres. As a result of starvation, dysfunction develops in virtually all systems and organs. However, most frequently patients with AN complain of digestive symptoms, such as a feeling of fullness after meals, pain in the upper abdomen, dysphagia, nausea, bloating and constipation. They can have mild functional character, but may also reflect serious complications, including diseases requiring urgent surgical intervention. In addition, gastric complaints may hinder nutritional management of AN. Care of AN patients requires cooperation of many specialists in the field of psychiatry, psychology, paediatrics, internal medicine and nutrition. However, it is often difficult to organize such a team. Therefore, we decided to approach the issues of gastrointestinal symptoms and complications in the course of AN, and the rules of nutritional therapy.

12 citations


Cites background from "Achalasia may mimic anorexia nervos..."

  • ...Reports on patients with esophageal achalasia, who were initially misdiagnosed with anorexia nervosa have been published [9]....

    [...]


Journal ArticleDOI
TL;DR: Increased awareness of achalasia in ED treatment settings can help facilitate detection of achalasia, thereby reducing treatment delay, and reduce treatment delay.
Abstract: Introduction Achalasia is a rare oesophageal motility disorder characterized by physical, behavioural and psychosocial features that are strikingly similar to eating disorders (ED). Method A literature search of PubMed and Google Scholar identified 36 cases of achalasia from 11 countries misdiagnosed as ED between 1980 and 2013. Results On average, the typical misdiagnosed case was an 18-year-old female with an average weight loss of 16.2 kg. Vomiting behaviour in achalasia was distinguished by occurring after both solids and liquids, occurring in public, and worsening at night or while lying down, and was associated with pain relief. Manometric investigations of oesophageal functioning in clinical ED samples are few and have shown little evidence of dysmotility. Discussion Achalasia and ED share numerous clinical features including weight loss and vomiting. Pain associated with swallowing difficulties may lead to an increasingly restricted pattern of eating and food avoidance. Increased awareness of achalasia in ED treatment settings can help facilitate detection of achalasia, thereby reducing treatment delay. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.

12 citations



References
More filters

Journal ArticleDOI
TL;DR: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care, and the incidence of anorexia nervosa increased over the past century, until the 1970s.
Abstract: Objective To review the literature on the incidence and prevalence of eating disorders Methods We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases Results An average prevalence rate for anorexia nervosa of 03% was found for young females The prevalence rates for bulimia nervosa were 1% and 01% for young women and young men, respectively The estimated prevalence of binge eating disorder is at least 1% The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year The incidence of anorexia nervosa increased over the past century, until the 1970s Discussion Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care © 2003 by Wiley Periodicals, Inc Int J Eat Disord 34: 383–396, 2003

1,447 citations


Journal ArticleDOI
01 Oct 1986-Gut
TL;DR: Clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms of disordered upper gastrointestinal motor activity, and delayed gastric emptying is a frequent feature in primary anoresis nervosa and might be returned to normal with domperidone.
Abstract: Gastrointestinal motor function in patients with primary anorexia nervosa has rarely been investigated. We studied oesophageal motor activity in 30 consecutive patients meeting standard diagnostic criteria for primary anorexia nervosa (Feighner et al; DSM III). Seven were found to suffer from achalasia instead of primary anorexia nervosa, one from diffuse oesophageal spasm and one from severe gastro-oesophageal reflux and upper oesophageal sphincter hypertonicity, while partly non-propulsive and repetitive high amplitude, long duration contractions prevailed in the lower oesophagus of another six. In four patients with oesophageal dysmotility not responding to therapy and in 12 of 15 patients with normal oesophageal manometry, gastric emptying of a semisolid meal was studied. Emptying was normal in only three but markedly delayed in 13 cases (half emptying times 97-330 min, median: 147 min, as compared with 21-119 min, median: 47 min, in 24 healthy controls). In eight patients, the effects of domperidone 10 mg iv and placebo were compared under random double blind conditions. Half emptying times were shortened significantly (p less than 0.01) by domperidone. Conclusions: symptoms of disordered upper gastrointestinal motor activity may be mistaken as indicating primary anorexia nervosa; clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms; delayed gastric emptying is a frequent feature in primary anorexia nervosa and might be returned to normal with domperidone.

120 citations


"Achalasia may mimic anorexia nervos..." refers background in this paper

  • ...First, it has been reported that esophageal motor disorders are common in patients with a diagnosis of primary anorexia nervosa.(7) For example, patients with eating disorders frequently have gastric emptying abnormalities causing bloating, postprandial fullness, and vomiting....

    [...]


Journal ArticleDOI
TL;DR: Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.
Abstract: Anorexia nervosa (AN) and bulimia nervosa (BN) are potentially fatal eating disorders which primarily affect adolescent females. Differentiating eating disorders from primary gastrointestinal (GI) disease may be difficult. GI disorders are common in eating disorder patients, symptomatic complaints being seen in over half. Moreover, many GI diseases sometimes resemble eating disorders. Inflammatory bowel disease, acid peptic diseases, and intestinal motility disorders such as achalasia may mimic eating disorders. However, it is usually possible to distinguish these by applying the diagnostic criteria for eating disorders and by obtaining common biochemical tests. The primary features of AN are profound weight loss due to self starvation and body image distortion; BN is characterized by binge eating and self purging of ingested food by vomiting or laxative abuse. GI complications in eating disorders are common. Recurrent emesis in BN is associated with dental abnormalities, parotid enlargement, and electrolyte disturbances including metabolic alkalosis. Hyperamylasemia of salivary origin is regularly seen, but may lead do an erroneous diagnosis of pancreatitis. Despite the weight loss often seen in eating disorders, serum albumin, cholesterol, and carotene are usually normal. However, serum levels of trace metals such as zinc and copper often are depressed, and hypophosphatemia can occur during refeeding. Patients with eating disorders frequently have gastric emptying abnormalities, causing bloating, postprandial fullness, and vomiting. This usually improves with refeeding, but sometimes treatment with pro-motility agents such as metoclopromide is necessary. Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.

80 citations


"Achalasia may mimic anorexia nervos..." refers background in this paper

  • ...with refeeding, but sometimes promotility agents may be necessary.(8) Sec-...

    [...]


Journal ArticleDOI
TL;DR: A careful symptomatic history focusing on aspiration, regurgitation and cough may identify the unusual combination of achalasia and morbid obesity.
Abstract: Background: The simultaneous occurrence of achalasia and morbid obesity is rare. Nevertheless, the surgical therapy of morbid obesity may be harmful, if undiagnosed achalasia were left untreated. We report the clinical presentation and response to treatment of achalasia in the context of morbid obesity. Methods: From 1998 to 2002, 638 patients underwent surgery for morbid obesity. Preoperative upper gastrointestinal radiography was performed in all patients. Three patients had manometric confirmation of achalasia. The characteristic symptoms were recurrent episodes of regurgitation, chronic cough and aspiration. No patient reported dysphagia or recent weight loss. Results: All patients had a duodenal switch procedure and in two a concurrent Heller myotomy was added. The other patient required a Heller myotomy after a duodenal switch had been performed, because the motility study was initially misinterpreted. All patients reported gradual resolution of presenting symptoms after myotomy. Conclusions: A careful symptomatic history focusing on aspiration, regurgitation and cough may identify the unusual combination of achalasia and morbid obesity. Treatment of morbid obesity alone may lead to progression of pulmonary symptoms.

41 citations


"Achalasia may mimic anorexia nervos..." refers background in this paper

  • ...Moreover, previous obesity of the patient is of interest, since an association between morbid obesity and achalasia has been described.(5) This, along with episodes of asthma,(6) leads us to believe that the patient probably had his achalasia before his symptoms of dysphagia....

    [...]


Journal ArticleDOI
TL;DR: Achalasia remains an elusive diagnosis in current practice, and errors in diagnosis are related to delay in obtaining appropriate studies or misinterpretation of such studies, and this delay leads to persistent symptoms and ineffective and/or inappropriate therapies.
Abstract: An impression that achalasia remains an elusive diagnosis led us to review our recent experience From August 1, 1985 to March 31, 1987, we saw 25 patients with "previously untreated" achalasia for consultation and/or treatment Data was extracted from review of their records Achalasia was the initial diagnosis in only 12 patients The others were given diagnoses of gastroesophageal reflux (4), presbyesophagus (2), esophageal spasm (2), psychiatric disorders (2), and combination of various disorders (3) In the latter patients, various diagnostic studies were either inappropriately delayed or misinterpreted, so that incorrect diagnoses were given Errors in diagnosis led to further inappropriate testing and therapies We conclude that: (a) achalasia remains an elusive diagnosis in current practice, (b) errors in diagnosis are related to delay in obtaining appropriate studies or misinterpretation of such studies, and (c) this delay leads to persistent symptoms and ineffective and/or inappropriate therapies

39 citations


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The authors report the case of a young man referred for evaluation of anorexia nervosa, who, after investigation, turned out to be suffering from achalasia.