Abstract
Three clinical criteria have been reported to distinguish patients with primary achalasia from patients with achalasia secondary to tumor invasion of the gastroesophageal junction. These criteria (age greater than 50 years, duration of symptoms less than one year, and weight loss greater than 15 pounds) are important because of their potential use for deciding between pneumatic dilation and exploratory surgery. In the present investigation we assessed the frequency of these criteria alone and in combination in 79 patients with primary and in two patients with secondary achalasia seen at our institution over a 91/2-year period. Our results indicate that while these criteria are highly sensitive and moderately specific, their predictive value for distinguishing secondary achalasia from primary achalasia is exceedingly low. For this reason, early exploratory surgery is not indicated in patients with newly diagnosed achalasia who meet these criteria unless there is prior radiologic or endoscopic evidence for tumor.
Similar content being viewed by others
References
Tucker HJ, Snape WJ Jr, Cohen S: Achalasia secondary to carcinoma: Manometric and clinical features. Ann Intern Med 89: 315–318, 1978
Davis JA, Kantrowitz PA, Chandler HL, Schatzki SC: Reversible achalasia due to reticulum-cell sarcoma. N Engl J Med 293: 130–132, 1975
Bessent CT, Lopez CA, Cocco AE: Carcinoma of the EG junction mimicking achalasia. Md State Med J 22: 47–50, 1973
Herrera AF, Colon J, Valdes-Dapena A, Roth JLA: Achalasia or carcinoma? The significance of the mecholyl test. Am J Dig Dis 15: 1073–1081, 1970
Shulze KS, Goresky CA, Jabbari M, Lough JO: Esophageal achalasia associated with gastric carcinoma: Lack of evidence for widespread plexus destruction. Can Med Assoc J 112: 857–864, 1975.
Asherson N: Cardiospasm: Intermittent: An initial manifestation of carcinoma of the cardia. Br J Tuber 47: 39–41, 1952
Seaman WB, Wells J, Flood CA: Diagnostic problems of esophageal cancer: Relationship to achalasia and hiatus hernia. Am J Roentgen 90: 778–791, 1963.
Kolodny M, Schrader ZR, Rubin W, Hochman R, Sleisenger MH: Esophageal achalasia probably due to gastric carcinoma. Ann Int Med 69: 569–573, 1968
Kline MM: Successful treatment of vigorous achalasia associated with gastric lymphoma. Dig Dis Sci 25: 311–313, 1980
Ullal SR: Achalasia: An unusual manifestation of carcinoma of the cardia. J Indian Med Assoc 60: 431–432, 1973
Vantrappen G, Hellemans J: Treatment of achalasia and related motor disorders. Gastroenterology 79: 144–154, 1980
Orlando RC, Bozymski EM: The effect of pentagastrin in achalasia and diffuse esophageal spasm. Gastroenterology 77: 472–477, 1979
Author information
Authors and Affiliations
Additional information
This investigation was supported in part by grant CA 17973 awarded by the National Institutes of Health.
Rights and permissions
About this article
Cite this article
Sandler, R.S., Bozymski, E.M. & Orlando, R.C. Failure of clinical criteria to distinguish between primary achalasia and achalasia secondary to tumor. Digest Dis Sci 27, 209–213 (1982). https://doi.org/10.1007/BF01296916
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296916