Pseudoachalasia of the Cardia: A Review

In 1947 Ogilvie recognized the syndrome of neoplastic involvement of the distal oesophagus mimicking idiopathic achalasia", with submucosal infiltration of the lower oesophagus and cardia by carcinoma, which is now commonly referred to as pseudoachalasia. The treatment and prognosis of these two conditions are very different, but their differentiation can be extremely difficult even with the use of contrast radiology, oesophageal manometry, response of the lower oesophageal sphincter to cholinergics and upper gastrointestinal endoscopy with biopsy (Table 1). We have seen 3 such cases recently which highlight the importance of thorough investigation of patients thought to have achalasia if an early carcinoma of the cardia is not to be missed. The clues in the histories which raised suspicion of malignant disease were the short duration of dysphagia, associated with marked weight loss in patients greater than 50 years 01d2•3• In this paper current methods of diagnosis and aetiology are discussed and we emphasize the importance of endoscopy to determine the resistance of the cardia and multiple biopsy prior to treatment and suggest that CT scanning may have a useful place in the investigation of pseudoachalasia.