Abstract
This study investigates whether the frequentlydelayed diagnosis of achalasia is attributable toatypical symptoms, misleading diagnostic features, orthe number of physicians consulted. Eighty-sevenconsecutive patients with newly diagnosed achalasia wereprospectively investigated with the use of structuredinterviews as well as manometric, endoscopic, andradiographic studies. The mean duration of symptoms was 4.7 ± 6.4 years. Quality and intensityof symptoms had no effect on early diagnosis. Amongdifferent radiographic and manometric features, only thewidth of the gastric cardia showed a significantcorrelation with a delay in diagnosis (P < 0.01).However, the most significant association was foundbetween the duration of symptoms prior to consideringthe diagnosis of achalasia and the number ofunsuccessful physician consultations (P = 0.001). We conclude that thefrequent delay in the diagnosis of achalasia is not dueto an atypical clinical presentation of this disease butrather to misinterpretation of typical findings by the physician consulted.
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REFERENCES
Sawyers JL, Foster JH: Surgical considerations in the management of achalasia of the esophagus. Ann Surg 165:780–785, 1967
Grimes OF, Stephens HB, Margulis AR: Achalasia of the esophagus. Am J Surg 120:198–202, 1970
Vantrappen G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J: Treatment of achalasia with pneumatic dilatations. Gut 12:268–275, 1971
Black J, Vorbach AN, Collis JN: Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair. Br J Surg 63:949–953, 1976
Menzies-Gow N, Gummer JWP, Edwards DAW: Results of Heller's operation for achalasia of the cardia. Br J Surg 65:483–485, 1978
Fellows IW, Ogilvie AL, Atkinson M: Pneumatic dilatation in achalasia. Gut 24:1020–1023, 1983
Wong RKH, Johnson LF: Achalasia. In Esophageal Function in Health and Disease. DO Castell, LF Johnson (eds). New York, Elsevier Biomedical, 1983, pp 99–123
Arber N, Grossman A, Lurie B, Hoffman M, Rubinstein A, Lilos P, Rozen P, Gilat T: Epidemiology of achalasia in Central Israel. Rarity of esophageal cancer. Dig Dis Sci 38:1920–1925, 1993
Eckardt VF, Aignherr C, Bernhard G: Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103:1732–1738, 1992
Olsen AM, Holman CB, Andersen HA: The diagnosis of cardiospasm. Dis Chest 23:477–498, 1953
Adams CWM, Brain RHF, Ellis FG, Kauntze R, Trounce JR: Achalasia of the cardia. Guy's Hosp Rev 110:191–236, 1961
Goldenberg SP, Burrell M, Fette GG, Vos C, Traube M: Classic and vigorous achalasia: A comparison of manometric, radiographic, and clinical findings. Gastroenterology 101:743–748, 1991
Dakkak M, Bennett JR: A new dysphagia score with objective validation. J Clin Gastroenterol 14:99–100, 1992
Stacher G, Kiss A, Wiesnagrotzki S, Bergmann H, Hobart J, Schneider C: Oesophageal and gastric motility disorders in patients categorized as having primary anorexia nervosa. Gut 27:1120–1126, 1986
Goldenberg SP, Vos C, Burrell M, Traube M: Achalasia and hiatal hernia. Dig Dis Sci 37:528–531, 1992
Bruggemann LL, Seaman WB: Epiphrenic diverticula—an analysis of 80 cases. Am J Radiol 119:266–276, 1973
Debas HT, Payne WS, Cameron AJ, Carlson HC: Pathophysiology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet 151:593–600, 1980
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Eckardt, V., Kohne, U., Junginger, T. et al. Risk Factors for Diagnostic Delay in Achalasia. Dig Dis Sci 42, 580–585 (1997). https://doi.org/10.1023/A:1018855327960
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DOI: https://doi.org/10.1023/A:1018855327960