Adenocarcinoma of the gastroesophageal junction presenting as achalasia

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Primary achalasia of the esophagus is a disease of unknown etiology characterized by failure of the lower esophageal sphincter to relax in response to swallowing and the absence of peristaltic activity in the body of the esophagus. Occasionally, carcinoma of the stomach and other tumors involving the gastroesophageal junctional area may have the presenting symptoms of achalasia.1–6 It may be difficult to differentiate between primary and secondary achalasia, but it is important from the standpoint of selecting appropriate therapy. We report two cases of adenocarcinoma of the stomach presenting initially as achalasia.

Case 1. A 36-year-old black male was admitted with a 3- to 4-week history of intermittent dysphagia accompanied by vague substernal pain. The dysphagia was initiated by both solid foods and liquids. Cold liquids were particularly difficult to swallow. There was no history of nausea, vomiting, weight loss, or chest pain between meals. A laparotomy had been performed 12 years earlier for a gunshot wound of the abdomen, but there were no other unusual events in the history.

The physical examination was unremarkable. A barium meal showed dilatation of the entire esophagus with distal narrowing and delay of the passage of barium. The end of the esophagus was tapered and the mucosa appeared normal (Fig. 1). The roentgenographic diagnosis was achalasia. On endoscopic examination, the esophagus was dilated and no peristaltic movements were observed. The esophagogastric junction was tight, but the instrument could be passed through to the stomach with slight pressure. Retrograde views of the cardia . . .



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