Skip to main content
SpringerLink
Log in

Achalasia and Disordered Eating Behaviours

  • Chapter
  • First Online:
Hidden and Lesser-known Disordered Eating Behaviors in Medical and Psychiatric Conditions

  • 1075 Accesses

Abstract

Achalasia is a rare motility disorder of the oesophagus characterized by the absence of oesophageal peristalsis with impaired relaxation of the inferior oesophageal sphincter. This pathology manifests itself mainly with dysphagia for solid and liquid food, regurgitations, retrosternal pain and weight loss. Although its cause remains largely unknown, genetic, neurodegenerative, infectious and autoimmune mechanisms have been discussed as triggers for the destruction of inhibitory neurons in the myenteric plexus. The diagnosis of achalasia rests on personal history detailing the quality of deglutition and the characteristics of vomiting episodes, an oeso-gastro-duodenal transit investigation to detect megaoesophagus or food stasis and the assessment of oesophageal motility using manometry. Current therapeutic options are pneumatic dilation, surgical Heller myotomy, per-oral endoscopic myotomy and pharmacological agents intended to facilitate oesophageal emptying. Interestingly, feeding or eating disorders (ED) can be primarily explained by or associated with an organic trouble. Achalasia shares physical and behavioural features with ED, such as vomiting and/or weight loss, that can lead to mistaken diagnoses or delay to appropriate treatment. Health professionals should be attentive to ensure a multidisciplinary approach to the diagnosis and treatment of complex cases with interwoven somatic and psychiatric features.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Birgisson S, Richter JE. Achalasia in Iceland, 1952-2002: an epidemiologic study. Dig Dis Sci. 2007;52:1855–60. https://doi.org/10.1007/s10620-006-9286-y.

    Article  PubMed  Google Scholar 

  2. Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313:1841–52. https://doi.org/10.1001/jama.2015.2996.

    Article  PubMed  Google Scholar 

  3. Franklin AL, Petrosyan M, Kane TD. Childhood achalasia: a comprehensive review of disease, diagnosis and therapeutic management. World J Gastrointest Endosc. 2014;6:105–11. https://doi.org/10.4253/wjge.v6.i4.105.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108:1238–49; quiz 1250. https://doi.org/10.1038/ajg.2013.196.

    Article  PubMed  Google Scholar 

  5. Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22:e256–61. https://doi.org/10.1111/j.1365-2982.2010.01511.x.

    Article  CAS  PubMed  Google Scholar 

  6. Eckardt VF, Köhne U, Junginger T, Westermeier T. Risk factors for diagnostic delay in achalasia. Dig Dis Sci. 1997;42:580–5. https://doi.org/10.1023/a:1018855327960.

    Article  CAS  PubMed  Google Scholar 

  7. O’Neill OM, Johnston BT, Coleman HG. Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2013;19:5806–12. https://doi.org/10.3748/wjg.v19.i35.5806.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chuah SK, Hsu PI, Wu KL, Wu DC, Tai WC, Changchien CS. 2011 update on esophageal achalasia. World J Gastroenterol. 2012;18:1573–8. https://doi.org/10.3748/wjg.v18.i14.1573.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Alhussaini B, Gottrand F, Goutet JM, Scaillon M, Michaud L, Spyckerelle C, et al. Clinical and manometric characteristics of Allgrove syndrome. J Pediatr Gastroenterol Nutr. 2011;53:271–4. https://doi.org/10.1097/MPG.0b013e31821456ba.

    Article  PubMed  Google Scholar 

  10. Zárate N, Mearin F, Gil-Vernet JM, Camarasa F, Malagelada JR. Achalasia and Down’s syndrome: coincidental association or something else? Am J Gastroenterol. 1999;94:1674–7. https://doi.org/10.1111/j.1572-0241.1999.01161.x.

    Article  PubMed  Google Scholar 

  11. Faure C, Viarme F, Cargill G, Navarro J, Gaultier C, Trang H. Abnormal esophageal motility in children with congenital central hypoventilation syndrome. Gastroenterology. 2002;122:1258–63. https://doi.org/10.1053/gast.2002.33062.

    Article  PubMed  Google Scholar 

  12. Jones DB, Mayberry JF, Rhodes J, Munro J. Preliminary report of an association between measles virus and achalasia. J Clin Pathol. 1983;36:655–7. https://doi.org/10.1136/jcp.36.6.655.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Robertson CS, Martin BA, Atkinson M. Varicella-zoster virus DNA in the oesophageal myenteric plexus in achalasia. Gut. 1993;34:299–302. https://doi.org/10.1136/gut.34.3.299.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. de Oliveira RB, Rezende Filho J, Dantas RO, Iazigi N. The spectrum of esophageal motor disorders in Chagas’ disease. Am J Gastroenterol. 1995;90:1119–24.

    PubMed  Google Scholar 

  15. Booy JD, Takata J, Tomlinson G, Urbach DR. The prevalence of autoimmune disease in patients with esophageal achalasia. Dis Esophagus. 2012;25:209–13. https://doi.org/10.1111/j.1442-2050.2011.01249.x.

    Article  CAS  PubMed  Google Scholar 

  16. Kraichely RE, Farrugia G, Pittock SJ, Castell DO, Lennon VA. Neural autoantibody profile of primary achalasia. Dig Dis Sci. 2010;55:307–11. https://doi.org/10.1007/s10620-009-0838-9.

    Article  PubMed  Google Scholar 

  17. De León AR, de la Serna JP, Santiago JL, Sevilla C, Fernández-Arquero M, de la Concha EG, et al. Association between idiopathic achalasia and IL23R gene. Neurogastroenterol Motil. 2010;22:734–738.e218. https://doi.org/10.1111/j.1365-2982.2010.01497.x.

    Article  CAS  PubMed  Google Scholar 

  18. Nuñez C, García-González MA, Santiago JL, Benito MS, Mearín F, de la Concha EG, et al. Association of IL10 promoter polymorphisms with idiopathic achalasia. Hum Immunol. 2011;72:749–52. https://doi.org/10.1016/j.humimm.2011.05.017.

    Article  CAS  PubMed  Google Scholar 

  19. Verne GN, Hahn AB, Pineau BC, Hoffman BJ, Wojciechowski BW, Wu WC. Association of HLA-DR and -DQ alleles with idiopathic achalasia. Gastroenterology. 1999;117:26–31. https://doi.org/10.1016/s0016-5085(99)70546-9.

    Article  CAS  PubMed  Google Scholar 

  20. Wong RK, Maydonovitch CL, Metz SJ, Baker JR. Significant DQw1 association in achalasia. Dig Dis Sci. 1989;34:349–52. https://doi.org/10.1007/bf01536254.

    Article  CAS  PubMed  Google Scholar 

  21. Gockel I, Becker J, Wouters MM, Niebisch S, Gockel HR, Hess T, et al. Common variants in the HLA-DQ region confer susceptibility to idiopathic achalasia. Nat Genet. 2014;46:901–4. https://doi.org/10.1038/ng.3029.

    Article  CAS  PubMed  Google Scholar 

  22. Tsuboi K, Hoshino M, Srinivasan A, Yano F, Hinder RA, Demeester TR, et al. Insights gained from symptom evaluation of esophageal motility disorders: a review of 4,215 patients. Digestion. 2012;85:236–42. https://doi.org/10.1159/000336072.

    Article  PubMed  Google Scholar 

  23. Ates F, Vaezi MF. The pathogenesis and management of achalasia: current status and future directions. Gut Liver. 2015;9:449–63. https://doi.org/10.5009/gnl14446.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Zendehdel K, Nyrén O, Edberg A, Ye W. Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. Am J Gastroenterol. 2011;106:57–61. https://doi.org/10.1038/ajg.2010.449.

    Article  PubMed  Google Scholar 

  25. Miyamoto S, Konda Y, Matsui M, Sawada K, Ikeda K, Watanabe N, et al. Acute airway obstruction in a patient with achalasia. Intern Med Tokyo Jpn. 2011;50:2333–6. https://doi.org/10.2169/internalmedicine.50.5603.

    Article  Google Scholar 

  26. Pandolfino JE, Kahrilas PJ. American Gastroenterological Association. American Gastroenterological Association medical position statement: clinical use of esophageal manometry. Gastroenterology. 2005;128:207–8. https://doi.org/10.1053/j.gastro.2004.11.007.

    Article  PubMed  Google Scholar 

  27. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–33. https://doi.org/10.1053/j.gastro.2008.07.022.

    Article  PubMed  Google Scholar 

  28. Bortolotti M, Mari C, Lopilato C, Porrazzo G, Miglioli M. Effects of sildenafil on esophageal motility of patients with idiopathic achalasia. Gastroenterology. 2000;118:253–7. https://doi.org/10.1016/s0016-5085(00)70206-x.

    Article  CAS  PubMed  Google Scholar 

  29. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12; discussion 412-415. https://doi.org/10.1097/01.sla.0000136940.32255.51.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71. https://doi.org/10.1055/s-0029-1244080.

    Article  CAS  PubMed  Google Scholar 

  31. Bonatti H, Hinder RA, Klocker J, Neuhauser B, Klaus A, Achem SR, et al. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg. 2005;190:874–8. https://doi.org/10.1016/j.amjsurg.2005.08.012.

    Article  PubMed  Google Scholar 

  32. Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248:986–93. https://doi.org/10.1097/SLA.0b013e3181907bdd.

    Article  PubMed  Google Scholar 

  33. von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, et al. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012;107:411–7. https://doi.org/10.1038/ajg.2011.388.

    Article  Google Scholar 

  34. Khashab MA, Vela MF, Thosani N, Agrawal D, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the management of achalasia. Gastrointest Endosc. 2019; https://doi.org/10.1016/j.gie.2019.04.231.

  35. Däbritz J, Domagk D, Monninger M, Foell D. Achalasia mistaken as eating disorders: report of two children and review of the literature. Eur J Gastroenterol Hepatol. 2010;22:775–8. https://doi.org/10.1097/MEG.0b013e3283325d71.

    Article  PubMed  Google Scholar 

  36. Reas DL, Zipfel S, Rø Ø. Is it an eating disorder or achalasia or both? A literature review and diagnostic challenges. Eur Eat Disord Rev. 2014;22:321–30. https://doi.org/10.1002/erv.2307.

    Article  PubMed  Google Scholar 

  37. Richterich A, Brunner R, Resch F. Achalasia mimicking prepubertal anorexia nervosa. Int J Eat Disord. 2003;33:356–9. https://doi.org/10.1002/eat.10144.

    Article  PubMed  Google Scholar 

  38. Bern EM, O’Brien RF. Is it an eating disorder, gastrointestinal disorder, or both? Curr Opin Pediatr. 2013;25:463–70. https://doi.org/10.1097/MOP.0b013e328362d1ad.

    Article  PubMed  Google Scholar 

  39. Mehler PS. Medical complications of bulimia nervosa and their treatments. Int J Eat Disord. 2011;44:95–104. https://doi.org/10.1002/eat.20825.

    Article  PubMed  Google Scholar 

  40. Zipfel S, Sammet I, Rapps N, Herzog W, Herpertz S, Martens U. Gastrointestinal disturbances in eating disorders: clinical and neurobiological aspects. Auton Neurosci. 2006;129:99–106. https://doi.org/10.1016/j.autneu.2006.07.023.

    Article  CAS  PubMed  Google Scholar 

  41. Benini L, Todesco T, Frulloni L, Dalle Grave R, Campagnola P, Agugiaro F, et al. Esophageal motility and symptoms in restricting and binge-eating/purging anorexia. Dig Liver Dis. 2010;42:767–72. https://doi.org/10.1016/j.dld.2010.03.018.

    Article  PubMed  Google Scholar 

  42. Cook IJ. Diagnostic evaluation of dysphagia. Nat Clin Pract Gastroenterol Hepatol. 2008;5:393–403. https://doi.org/10.1038/ncpgasthep1153.

    Article  PubMed  Google Scholar 

  43. Gravier V, Naja W, Blaise M, Cremniter D. Achalasia and megaesophagus misdiagnosed as anorexia nervosa. Eur Psychiatry. 1998;13:315–6. https://doi.org/10.1016/S0924-9338(98)80050-3.

    Article  CAS  PubMed  Google Scholar 

  44. Blam ME, Delfyett W, Levine MS, Metz DC, Katzka DA. Achalasia: a disease of varied and subtle symptoms that do not correlate with radiographic findings. Am J Gastroenterol. 2002;97:1916–23. https://doi.org/10.1111/j.1572-0241.2002.05900.x.

    Article  PubMed  Google Scholar 

  45. Kutuk MO, Guler G, Tufan AE, Toros F, Kaytanli U. Achalasia as a complication of bulimia nervosa: a case report. S Afr J Psychiatr. 2017;23:996. https://doi.org/10.4102/sajpsychiatry.v23.996.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Teufel M, Lamprecht G, Zipfel S, Schrauth M, Rapps N, Martens U, et al. Vomiting and feeling fat—coincidence of achalasia and bulimia nervosa. Int J Eat Disord. 2009;42:90–2. https://doi.org/10.1002/eat.20582.

    Article  PubMed  Google Scholar 

  47. De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10:52–77. https://doi.org/10.1002/j.2051-5545.2011.tb00014.x.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Adolescent and Young Adult Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France

    Aurélie Letranchant

Authors
  1. Aurélie Letranchant
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aurélie Letranchant .

Editor information

Editors and Affiliations

  1. Private Hospital "Salus" of Ferrara, University of Ferrara, Ferrara, Italy

    Emilia Manzato

  2. Formerly Sapienza University of Rome, Founding Editor of Eating and Weight Disorders, Campiglia Marittima, Livorno, Italy

    Massimo Cuzzolaro

  3. Experimental Medicine Department, Sapienza University of Rome, Editor-in-Chief of Eating and Weight Disorders, Roma, Roma, Italy

    Lorenzo Maria Donini

Ethics declarations

There is no conflict of interest.

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Letranchant, A. (2022). Achalasia and Disordered Eating Behaviours. In: Manzato, E., Cuzzolaro, M., Donini, L.M. (eds) Hidden and Lesser-known Disordered Eating Behaviors in Medical and Psychiatric Conditions . Springer, Cham. https://doi.org/10.1007/978-3-030-81174-7_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81174-7_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81173-0

  • Online ISBN: 978-3-030-81174-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation