Carcinoma of the gastric cardia with secondary achalasia. Manometric and clinical features

Carcinoma of the gastric cardia and primary idiopathic achalasia have many common features both clinically and radiologically. Radiologic findings in a classical case of achalasia may show dilatation of the esophageal lumen, smoothly tapered narrowing of the distal esophagus, and absence of peristaltic waves in the esophageal body. The typical manometric findings should demonstrate aperistalsis of the esophageal body, incomplete relaxation of the lower esophageal sphincter in response to swallowing, and elevation of lower esophageal sphincter pressure (LESP). Carcinoma of the gastric cardia causing obstruction of the esophageal outlet, with invasion or infiltration of the lower esophageal sphincter by the malignant cells, may result in manometric pictures, sometimes but infrequently, mimicking idiopathic achalasia. A case of carcinoma of the gastric cardia is presented with manometric findings similar to achalasia, and the approach used to manage this kind of patients is described.