Malignancy-induced secondary achalasia.
Secondary achalasia refers to the development of clinical, radiographic, and manometric findings of achalasia as a result of (i.e., secondary to) another underlying disorder. A variety of malignancies have been associated with secondary achalasia. Adenocarcinoma of the esophagogastric junction accounts for the majority of cases of malignancy-induced achalasia, however, noncontiguous tumors may also cause this disorder. Although rare, malignancy-induced achalasia will occasionally be encountered by gastroenterologists and gastrointestinal radiologists who see patients with dysphagia and/or achalasia. Since treatment is aimed at the underlying neoplasm, it is important to recognize this disorder. Three clinical features suggest the possibility of malignancy as a cause of achalasia: 1) short duration of dysphagia (< 1 year); 2) significant weight loss (> 15 pounds); and 3) age > 55 years. The presence of any of these should at least raise a suspicion of malignancy. Diagnosis may not be evident on routine esophagrams and endoscopy, and requires clinical suspicion for further evaluation with thoraco-abdominal CT scanning and endoscopic ultrasonography.
Parkman
H P
HP
Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140.
Cohen
S
S
D004931:Esophageal Achalasia / Q000209:etiology* / Q000503:physiopathology; D004938:Esophageal Neoplasms / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications* / Q000175:diagnosis