Mimickers of Esophageal Achalasia

Achalasia may be mimicked on chest radiographs or barium swallow studies by the following conditions:

• Gastric or esophageal carcinoma: Mass at the esophagogastric junction may mimic achalasia, but tends to involve a longer segment of the distal esophagus with a more irregular tapering of the distal esophagus (as opposed to the smooth beak). Mass effect on adjacent structures can also be seen.
• Lung cancer: Due to compression by mediastinal lymphadenopathy, direct tumor invasion of mediastinum, radiotherapy, or secondary achalasia (damage to myenteric plexus of esophagus).
• Scleroderma: Primary stripping wave is absent.
• Colon adenocarcinoma: Autoimmune gastrointestinal dysmotility due to a paraneoplastic syndrome.
• Amyloidosis:
• Chagas disease:
• Collagen-vascular disease:
• Lymphoma:

References

• Dhamija R, Tan KM, Pittock SJ, Foxx-Orenstein A, Benarroch E, Lennon VA. Serologic profiles aiding the diagnosis of autoimmune gastrointestinal dysmotility. Clin Gastroenterol Hepatol. 2008 Sep;6(9):988-92.
• Makker HK, Chisholm R, Rate AJ, Bancewicz J, Bernstein A. Dysphagia due to secondary achalasia as an early manifestation of squamous cell carcinoma. Postgrad Med J. 1995 Aug;71(838):502-4.