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Iatrogenic achalasia. A case series
T L Ellingson1, R A Kozarek, M D Gelfand
1Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
Journal of Clinical Gastroenterology
|March 1, 1995
Summary
Secondary achalasia, often caused by anti-reflux surgery, presents as a distinct condition. Pneumatic dilation is an effective treatment, sometimes requiring surgical intervention.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Esophageal Surgery
Background:
- Secondary achalasia is a rare condition.
- It can be caused by malignancy or esophageal surgery.
- Post-surgical achalasia is often misdiagnosed.
Purpose of the Study:
- To investigate the incidence and characteristics of secondary achalasia.
- To evaluate treatment outcomes for secondary achalasia.
- To differentiate post-surgical achalasia from other causes.
Main Methods:
- Retrospective review of 14 cases of secondary achalasia diagnosed between 1984 and 1992.
- Analysis of patient data including manometry, esophagram, and treatment outcomes.
- Comparison of surgical and non-surgical causes of secondary achalasia.
Main Results:
- Nine cases of secondary achalasia resulted from esophageal or paraesophageal surgery.
- All post-surgical patients developed dysphagia immediately after surgery.
- Pneumatic dilation was effective in 5/8 patients, with 2 requiring surgery.
Conclusions:
- Secondary achalasia due to tight antireflux repair is a distinct clinical entity.
- This condition impairs lower esophageal sphincter relaxation, causing functional obstruction.
- Pneumatic dilation is a primary therapeutic option, potentially disrupting tight surgical repairs.