Pseudoachalasia as first manifestation of a diffusely infiltrative esophageal squamous cell carcinoma: A case report

Table 1 Differences between achalasia and pseudoachalasia

Characteristic	Achalasia	Pseudoachalasia
Age	Average 40-60 years	Average 60 years
Gender	Both genders equally	Male predominance (3:2 ratio)
Pathophysiology	Inflammation and neuronal degeneration	Mechanical obstruction, submucosal infiltration, or paraneoplastic syndrome
Etiology	Unknown, autoimmune, or genetic	Malignancy (e.g., gastric adenocarcinoma); operation
Symptoms	Progressive dysphagia, retrosternal pain, regurgitation, weight loss	Similar to achalasia, but shorter symptom duration < 12 months, and often weight loss > 10 kg
Esophagogram	Bird’s beak appearance, tram-track sign	Same as with achalasia; irregularities in EGJ, longer narrowed segment (> 3.5 cm)
Endoscopy	Food retention, dilated lower esophagus	Food retention, dilated lower esophagus, difficulty in passing the EGJ, nodularity or ulceration
Manometry	Impaired LES relaxation, aperistalsis	Similar findings of HRM: Compartmentalized pressurization
Computed tomography imaging	Symmetrical wall thickening < 10 mm	Asymmetrical wall thickening > 10 mm, soft-tissue masses at EGJ
Management	Pneumatic dilation, botulinum toxin injection, Helle myotomy	Treat malignancy, surgical resection, chemotherapy, radiotherapy
Treatment outcome	Often effective in relieving symptoms	Poor prognosis

EGJ: Esophagogastric junction; LES: Lower esophageal sphincter; HRM: High-resolution manometry.