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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case of a young women with dysphagia, regurgitation, and weight loss, who was diagnosed as having anorexia nervosa but in whom reevaluation showed that achalasia was causing the symptoms, is presented together with related observations. Misinterpretation of esophageal symptoms may occur not only as a consequence of inadequate history taking and of being biased by a patient's emaciation, age, and gender, which leads to view certain aspects of the patient's history and behavior as suggesting a pathologic attitude towards eating and body weight, but also as a consequence of a misinterpretation of the symptoms as indicative of an eating disorder by the patients themselves. In some cases a disordered attitude toward eating and body weight may develop together or coexist with achalasia. The clinical evaluation of patients with symptoms suggestive of anorexia nervosa but also of bulimia nervosa should include the taking of a thorough history regarding swallowing and vomiting in order to recognize a possible esophageal motor disorder.
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PMID:Symptoms of achalasia in young women mistaken as indicating primary anorexia nervosa. 227 21

A report is given on a 14-year-old girl and a 13-year-old boy from a group of 83 patients who met the diagnostic criteria (MAS; DSM-III-R) for anorexia nervosa. The behavior therapy interventions did not have the expected effects in either child. On repetition diagnostic evaluations showed that the girl had esophageal achalasia within the scope of Turpin's syndrome (megaesophagus, bronchus deformation) and the boy Burkitt's lymphoma (malignant non-Hodgkins' lymphoma). The differential diagnostic and classification problems associated with the diagnosis anorexia nervosa are pointed out.
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PMID:[How reliable is the diagnosis "anorexia nervosa"?]. 228 65

Previous studies showed that symptoms of oesophageal motor disorders can be misinterpreted as indicating anorexia nervosa and that in primary anorexia nervosa gastric motility is frequently impaired. We investigated in 32 women with bulimia nervosa whether symptoms of oesophageal motor disorders could be obscured by or be mistaken as forming part of bulimic behaviour, and whether impaired gastric motility was frequent as well. Oesophageal motility was normal in 18 of 26 patients studied, another four had incomplete lower oesophageal sphincter relaxation. Two patients had vigorous achalasia and each one achalasia and diffuse oesophageal spasm, all of whom experienced two types of vomiting: one self-induced and one involuntary, in which the vomit was non-acidic and tasted as the preceding meal. Gastric emptying of a semisolid meal was studied in all patients except of the eight with oesophageal motor abnormalities. Emptying was significantly slower than in healthy controls and grossly delayed in nine of 24 patients. Antral contraction amplitudes were lower and increased less postcibally than in controls. In conclusion (i) bulimic behaviour can obscure symptoms of oesophageal motor disorders and (ii) gastric emptying is frequently delayed in bulimia nervosa.
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PMID:Oesophageal and gastric motor activity in patients with bulimia nervosa. 232 85

A case report of an adolescent female with esophageal achalasia and behavioral features of anorexia nervosa is presented. This unusual combination of problems may cause similar physical symptoms and thus create diagnostic confusion.
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PMID:Achalasia in an adolescent with behavioral features compatible with anorexia nervosa. 649 Apr 84

The authors present their experience with surgical treatment of achalasia of the oesophagus in child age. During a nine-year period (1984-1992) they operated 11 children with achalasia. The group comprised 6 boys and 5 girls. The mean age at the time of operation was 9.5 years. The youngest patient was operated at the age of 14 months and the oldest one at the age of 15 years. The main clinical symptoms at the time of establishment of the diagnosis were: vomiting in 91%, dysphagia in 64%, the children did not thrive and lost weight in 36%; they suffered from relapsing bronchopneumonia in 27%, chronic bronchitis in 9%, bronchial asthma in 9% and one female patient was treated and followed up on account of anorexia nervosa. In six patients a modification of Heller's operation was performed with left-sided thoracotomy which in three patients was supplemented by anti-reflux Belsey Mark IV plastic operation. During the last three years five patients were operated from an abdominal approach and myotomy was supplemented by Nissen fundoplication. At present the authors prefer and abdominal approach and supplement myotomy of the distal oesophagus by Nissen fundoplication.
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PMID:[Surgery of achalasia in childhood. The thoracic or abdominal approach?]. 805 19

We have reported a rather extreme instance in which achalasia was misdiagnosed as a primary eating disorder. Our patient spent 2 months in a psychiatric institution before the correct diagnosis was made. Misdiagnosis in this case could have been avoided (1) if the symptoms of dysphagia had been elicited as part of her history, (2) if it had been recognized that the vomiting (her dominant symptom) was involuntary and not self-induced, (3) if the absence of disturbed body image had been appreciated, or (4) if it had been recognized that she did not meet accepted criteria for anorexia nervosa or bulimia. Our case and others like it in the literature also illustrate that achalasia frequently remains an elusive diagnosis.
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PMID:Achalasia mistakenly diagnosed as eating disorder and prompting prolonged psychiatric hospitalization. 827 22

Anorexia nervosa (AN) and bulimia nervosa (BN) are potentially fatal eating disorders which primarily affect adolescent females. Differentiating eating disorders from primary gastrointestinal (GI) disease may be difficult. GI disorders are common in eating disorder patients, symptomatic complaints being seen in over half. Moreover, many GI diseases sometimes resemble eating disorders. Inflammatory bowel disease, acid peptic diseases, and intestinal motility disorders such as achalasia may mimic eating disorders. However, it is usually possible to distinguish these by applying the diagnostic criteria for eating disorders and by obtaining common biochemical tests. The primary features of AN are profound weight loss due to self starvation and body image distortion; BN is characterized by binge eating and self purging of ingested food by vomiting or laxative abuse. GI complications in eating disorders are common. Recurrent emesis in BN is associated with dental abnormalities, parotid enlargement, and electrolyte disturbances including metabolic alkalosis. Hyperamylasemia of salivary origin is regularly seen, but may lead do an erroneous diagnosis of pancreatitis. Despite the weight loss often seen in eating disorders, serum albumin, cholesterol, and carotene are usually normal. However, serum levels of trace metals such as zinc and copper often are depressed, and hypophosphatemia can occur during refeeding. Patients with eating disorders frequently have gastric emptying abnormalities, causing bloating, postprandial fullness, and vomiting. This usually improves with refeeding, but sometimes treatment with pro-motility agents such as metoclopromide is necessary. Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.
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PMID:Gastrointestinal and nutritional aspects of eating disorders. 840 9

Anorexia nervosa and psychogen vomiting are psychiatric eating disorders characterized by unexplained weight loss and induced vomiting. These diagnoses require absence of somatic disease. Achalasia is a primary disorder of the esophagus that can be responsible for the same symptoms. This may occult the real diagnosis, especially as dysphagia is not constant and variable in time. We report four cases of achalasia mistakenly diagnosed and treated as anorexia nervosa or psychogen vomiting. Achalasia was unrecognized because specific symptoms, such as dysphagia, were overlooked or misinterpreted by the patients' physicians and psychiatrists, or by the patients themselves. In patients with such eating disorders considered to be psychiatric, physicians should inquire about signs suggestive of achalasia. The diagnosis of achalasia is suspected by imaging and endoscopy, and confirmed or ruled out by manometry.
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PMID:[Achalasia mimicking psychiatric eating disorders]. 1139 78

A 9-year-old girl presents for continuing weight loss of 10 kg over the course of 1 year. Medical history showed three episodes of pneumonia requiring hospital admission in the 6 months before presentation and 4 months of weekly psychotherapy for anorexia nervosa. A thorough history of eating behavior and a review of systems revealed not only typical aspects of prepubertal anorexia nervosa but also vomiting at night while asleep, difficulty drinking liquids, epigastric pain, and a frequent experience of "a lump in the throat"; these symptoms were not suggestive of a diagnosis of anorexia nervosa but rather of esophageal achalasia. The patient was transferred to the Department of Pediatrics, and a diagnosis of esophageal achalasia was made by chest x-ray and barium swallow. After dilatation and botulinum toxin application, the patient regained weight easily and was discharged in stable condition. In this case, esophageal achalasia mimicked prepubertal anorexia nervosa.
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PMID:Achalasia mimicking prepubertal anorexia nervosa. 1265 33

A 40-year-old woman initially considered as suffering from anorexia nervosa was later diagnosed as having achalasia and megaesophagus.
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PMID:Achalasia and megaesophagus misdiagnosed as anorexia nervosa. 1969 47


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