# Delayed Presentation of Malignancy-Associated Pseudoachalasia of the Gastric Cardia

## TL;DR

This paper presents a case where a cancer-related condition mimicked achalasia, highlighting the need for timely endoscopy to detect underlying malignancies.

## Contribution

The paper emphasizes the importance of early endoscopic evaluation in pseudoachalasia to identify malignancies.

## Key findings

- A 65-year-old patient with pseudoachalasia was later diagnosed with gastric cardia adenocarcinoma.
- Timely esophagogastroduodenoscopy is critical to distinguish pseudoachalasia from primary achalasia.
- Diagnostic delays can occur due to nonspecific symptoms and imaging results in malignant pseudoachalasia.

## Abstract

Pseudoachalasia is a condition in which symptoms, manometry, and imaging findings highly resemble primary achalasia but has a secondary etiology. The majority of patients with pseudoachalasia have the condition as the result of a malignancy, most often at the gastroesophageal junction. There may be issues with timely identification of this malignancy as symptoms are often obscure with diagnostic testing yielding nonspecific results. We describe a case of a 65-year-old diabetic female smoker with a four-month history of intractable vomiting, abdominal pain, and weight loss who was belatedly found to have an adenocarcinoma at the gastric cardia necessitating a total gastrectomy and chemotherapy administration. The case educates clinicians on the clinical alarm symptoms related to malignant pseudoachalasia and stresses the paramount importance of performing a timely esophagogastroduodenoscopy in all cases of achalasia, even with seemingly normal imaging, to rule out pseudoachalasia related to malignancy.