title: Erroneous diagnosis of gastroesophageal reflux disease in achalasia.
abstract: OBJECTIVE
  Most experienced gastroenterologists have seen one or several cases of achalasia patients who have been erroneously diagnosed with gastroesophageal reflux disease (GERD) or even underwent antireflux surgery. We aim to describe the current knowledge about the diagnostic features of achalasia and their overlap with GERD. Furthermore, we present 3 cases in which achalasia was mistaken for GERD.
  
  
  METHODS
  Search of the literature published in English using the PubMed database and relevant abstracts presented at international conventions.
  
  
  RESULTS
  Typical features of GERD such as heartburn, retrosternal pain, esophagitis, and pathologic acid exposure can be observed in achalasia patients. Diagnostic tests such as endoscopy and radiography lack sensitivity and specificity for achalasia. Current diagnostic guidelines for antireflux surgery do not stipulate that achalasia should be ruled out preoperatively.
  
  
  CONCLUSIONS
  Clinical presentation as well as the diagnostic work-up of achalasia patients can show overlap with GERD. Mistaking achalasia for GERD can be avoided by esophageal manometry and this should therefore be performed in all patients undergoing surgical fundoplication.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. b.f.kessing@amc.uva.nl
authors.forename: Boudewijn F
authors.initials: BF
authors.lastname: Kessing
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Bredenoord
authors.forename: André J P M
authors.initials: AJ
authors.lastname: Smout
mesh_terms: D003951:Diagnostic Errors; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D004947:Esophagus / Q000502:physiology; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008365:Manometry