Achalasia differential diagnosis: Difference between revisions

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== Differentiating Achlasia from other Disease==  
== Differentiating Achlasia from other Disease==  
Achalasia must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, esophageal adenocarcinoma and esophageal stricture.
Achalasia must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, esophageal adenocarcinoma and esophageal stricture.
{| class="wikitable"
!
!Manifestations
!Diagnostic tools
|-
|Achalasia
|
* Dyspnea<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref>
*[[Dysphagia]] for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref>
*[[Regurgitation]] of undigested food occurs in 76-91% of patients<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
*[[Cough]] mainly when lying down in 30%<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
|
* Esophagogastroduodenoscopy findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]] (due to the prolonged stasis).
* Barium swallow shows the characteristic bird's beak appearance.
[[Image:Acha.jpg|center|300px|thumb|Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922]]
|-
|GERD
|
* Retrosternal burning chest pain.
* Cough and hoarseness of voice.
* May present with complications such as strictures and dysphagia.
|
* Upper GI endoscopy shows the complications such as esophagitis and barret esophagus.
* Esophageal manometry may show decreased tone of the lower esophageal sphincter.
* 24-hour esophageal pH monitoring may be done to confirm the diagnosis.
[[Image:Barretts esophagus.jpg|center|300px|thumb|Barret's esophagus - By Samir धर्म - taken from patient with permission to place in public domain, Copyrighted free use, https://commons.wikimedia.org/w/index.php?curid=1595945]]
|-
|Esophageal carcinoma
|
*[[Dysphagia]]
*[[Odynophagia]]- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty
*[[Weight loss]]
*[[Pain and nociception|Pain]], often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character
*[[Nausea]] and [[vomiting]]
|
* Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
[[Image:Esophageal adenoca.jpg|center|300px|thumb|CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2587715]]
|-
|Corckscrew esophagus
|
*Retrosternal chest pain that presents with or without food intake.
*The condition is not progressive and not causing complications.
|
* Barium swallow shows the characteristic corckscrew appearance of the esophagus.
[[Image:Nutcracker-esophagus-004.jpg|center|300px|thumb|Corckscrew esophagus - Case courtesy of Radswiki, Radiopaedia.org, rID: 11680]]
|-
|Esophageal stricture
|
*Patient may present with the symptoms of the underlying GERD.
*Dysphagia and odynophagia.
|
* Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention.
[[Image:Peptic stricture.png|center|300px|thumb|Peptic stricture - By Samir धर्म - From en.wikipedia.org, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1931423]]
|}


==References==
==References==

Revision as of 13:10, 1 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Due to the similarity of symptoms, achalasia can be misdiagnosed as other disorders, such as gastroesophageal reflux disease (GERD), hiatus hernia, and even psychosomatic disorders.

Differentiating Achlasia from other Disease

Achalasia must be differentiated from other causes of dysphagia, odynophagia and food regurgitation such as GERD, esophageal adenocarcinoma and esophageal stricture.

Manifestations Diagnostic tools
Achalasia
  • Dysphagia for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively[2]
  • Regurgitation of undigested food occurs in 76-91% of patients[2]
  • Cough mainly when lying down in 30%[2]
  • Esophagogastroduodenoscopy findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally candidiasis (due to the prolonged stasis).
  • Barium swallow shows the characteristic bird's beak appearance.
Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922
GERD
  • Retrosternal burning chest pain.
  • Cough and hoarseness of voice.
  • May present with complications such as strictures and dysphagia.
  • Upper GI endoscopy shows the complications such as esophagitis and barret esophagus.
  • Esophageal manometry may show decreased tone of the lower esophageal sphincter.
  • 24-hour esophageal pH monitoring may be done to confirm the diagnosis.
Barret's esophagus - By Samir धर्म - taken from patient with permission to place in public domain, Copyrighted free use, https://commons.wikimedia.org/w/index.php?curid=1595945
Esophageal carcinoma
  • Dysphagia
  • Odynophagia- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty
  • Weight loss
  • Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character
  • Nausea and vomiting
  • Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2587715
Corckscrew esophagus
  • Retrosternal chest pain that presents with or without food intake.
  • The condition is not progressive and not causing complications.
  • Barium swallow shows the characteristic corckscrew appearance of the esophagus.
Corckscrew esophagus - Case courtesy of Radswiki, Radiopaedia.org, rID: 11680
Esophageal stricture
  • Patient may present with the symptoms of the underlying GERD.
  • Dysphagia and odynophagia.
  • Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention.
Peptic stricture - By Samir धर्म - From en.wikipedia.org, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1931423

References

  1. ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  2. ↑ 2.0 2.1 2.2 Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.

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