Idiopathic achalasia mistakenly diagnosed as anorexia nervosa
01 Jun 2008-Revista Brasileira de Psiquiatria (Associação Brasileira de Psiquiatria (ABP))-Vol. 30, Iss: 2, pp 168-168
About: This article is published in Revista Brasileira de Psiquiatria.The article was published on 2008-06-01 and is currently open access. It has received 10 citations till now. The article focuses on the topics: Anorexia nervosa (differential diagnoses).
Citations
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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.
95 citations
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.
23 citations
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.
15 citations
TL;DR: The clinical case of a 46-year-old woman with a long-term delusion of triplet pregnancy, and recurrent vomiting is presented, illustrating the difficulty of establishing clinical-surgical diagnoses in psychotic patients.
Abstract: Abnormal eating behaviour among psychiatric patients is associated with several psychiatric conditions, but may also be caused by a comorbid physical condition. Clinical assessment of a psychiatric patient is often challenging, which contributes to an increased rate of undiagnosed medical conditions and an increased mortality rate. We present the clinical case of a 46-year-old woman with a long-term delusion of triplet pregnancy, and recurrent vomiting. She experienced intense weight loss and eventually faced a life-threatening situation due to achalasia, which was incidentally discovered on a chest X-ray during her second psychiatric hospitalization, after several other tests, including upper digestive endoscopy, returned normal results. After a successful laparoscopic Heller's myotomy, her digestive symptoms greatly improved. This report illustrates the difficulty of establishing clinical-surgical diagnoses in psychotic patients, as some delusions seem to explain clinical complaints, masking and delaying the diagnosis of comorbid conditions.
2 citations
01 Mar 2010
TL;DR: In this article, the authors characterized the idiopathic esophageal achalasia and proposed hypothesis concerning its etiology and associated factors, which seems to be highly related to emotional problems.
Abstract: BACKGROUND: The idiopathic esophageal achalasia is a disease of unknown etiology, characterized by esophageal aperistalsis and failure of its lower sphincter with dysphagia. Its etiology factors includes: esophageal gastric junction obstruction, degeneration of Auerbach´s plexus, virus infection, congenital origin, autoimmune affection and injury by toxic agent. The achalasia diagnosis is reached after excluding Chagas disease possibilities, which includes seronegative results for Trypanosoma cruzi, absence of megacolon and epidemiology for Chagas disease. AIM: To characterize the disease and propose hypothesis concerning its etiology and associated factors. METHODS: Review of medical records from 78 patients operated at the Hospital de Clinicas da Unicamp obstruction between 1989 and 2005 and the subsequent interview, using directed questionnaire, reaching for common data between them and emphasizing history, possible co-morbidities and associated factors. In the group of 78 records collected it was possible to contact and interview 33 patients. RESULTS: The main findings of this study were: 1) presence of a triggering relevant emotional factor before the symptoms (80%) and over 30% with psychiatric and/or psychological treatment reported; 2) typical childhood infections highly prevalent (88% measles, varicella, rubella); 3) possible associations with: exposure to chemicals, especially herbicides; other diseases of the gastrointestinal tract, autoimmune diseases, genetic propensity and other changes in the nervous system highlighting the seizures. CONCLUSIONS: The idiopathic esophageal achalasia is probably an autoimmune disease, which seems to be highly related to emotional problems.
1 citations
References
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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
40 citations
TL;DR: A 9-year-old girl presents for continuing weight loss of 10 kg over the course of 1 year and is diagnosed with esophageal achalasia, which mimicked prepubertal anorexia nervosa.
Abstract: A 9-year-old girl presents for continuing weight loss of 10kg over the course of 1 year. Medical history showed three episodes of pneumonia requiring hospital admission in the 6 months before presentation and 4 months of weekly psychotherapy for anorexia nervosa. A thorough history of eating behavior and a review of systems revealed not only typical aspects of prepubertal anorexia nervosa but also vomiting at night while asleep, difficulty drinking liquids, epigastric pain, and a frequent experience of “a lump in the throat”; these symptoms were not suggestive of a diagnosis of anorexia nervosa but rather of esophageal achalasia. The patient was transferred to the Department of Pediatrics, and a diagnosis of esophageal achalasia was made by chest x-ray and barium swallow. After dilatation and botulinum toxin application, the patient regained weight easily and was discharged in stable condition. In this case, esophageal achalasia mimicked prepubertal anorexia nervosa. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 356–359, 2003.
13 citations
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.
11 citations
Journal Article•
TL;DR: Colorectal motility disorders may present as abdominal pain, diarrhea, constipation and/or fecal incontinence, and if symptoms do not resolve with dietary changes and appropriate medications and the anatomy is normal on lower gastrointestinal studies, colorectAL motility studies may be indicated.
Abstract: A careful history can localize gastrointestinal motility disorders and suggest appropriate diagnostic tests. Dysphagia, odynophagia, heartburn and reflux have esophageal origins. The same symptoms occur in achalasia, a classic motor disorder of the lower esophageal sphincter, which can be diagnosed by barium swallow, endoscopy and esophageal motility studies. Nausea, vomiting, anorexia, bloating and abdominal pain are symptoms of motor disorders of the stomach and small intestine. When these symptoms are accompanied by unexplained right upper quadrant pain, elevated liver enzyme levels and unexplained recurrent pancreatitis, the diagnosis of impaired biliary motility is suggested. Colorectal motility disorders may present as abdominal pain, diarrhea, constipation and/or fecal incontinence. If symptoms do not resolve with dietary changes and appropriate medications and the anatomy is normal on lower gastrointestinal studies, colorectal motility studies may be indicated.
10 citations
6 citations