title: Association of pseudoachalasia with advancing cancer of the gastric cardia.
abstract: BACKGROUND
  Pseudoachalasia is attributable to malignant tumors of the gastric cardia in more than 50% of cases. Study of the progression of esophageal manometric abnormalities with increasing tumorous involvement of the esophagogastric junction may improve our understanding of the pathophysiologic characteristics of pseudoachalasia.
  
  
  METHODS
  During a 2-year period, esophageal manometric characteristics were evaluated for 17 of 21 consecutive patients with cancer of the gastric cardia. Manometry was not possible in the other four. Manometric parameters assessed included lower esophageal sphincter pressure, percentage lower esophageal sphincter relaxation, and percentage failed peristalsis. The extent of malignant involvement of the esophagogastric junction was graded as none, less than 50% of the circumference, or 50% or more of the circumference, assessed from surgical specimens in 13 cases and endoscopy in 4 cases.
  
  
  RESULTS
  Pseudoachalasia was diagnosed in 3 cases, all with 50% or greater circumferential involvement of the esophagogastric junction. The first manometric indication of evolving pseudoachalasia was impaired lower esophageal sphincter relaxation; loss of peristaltic function was a secondary consequence.
  
  
  CONCLUSIONS
  These findings suggest that the primary mechanism of pseudoachalasia with gastric cardia cancer is malignant stenosis of the esophagogastric junction.
authors.affiliation: Institute of Digestive Disease and Nutrition, Korea University, Seoul, Korea.
authors.forename: C W
authors.initials: CW
authors.lastname: Song
authors.forename: H J
authors.initials: HJ
authors.lastname: Chun
authors.forename: C D
authors.initials: CD
authors.lastname: Kim
authors.forename: H S
authors.initials: HS
authors.lastname: Ryu
authors.forename: J H
authors.initials: JH
authors.lastname: Hyun
authors.forename: P J
authors.initials: PJ
authors.lastname: Kahrilas
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000209:etiology*; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology; D004943:Esophagogastric Junction / Q000473:pathology / Q000503:physiopathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology