{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:08:38Z","timestamp":1792516118212,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T00:00:00Z","timestamp":1683504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,30]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Achalasia is a rare disease with significant diagnostic delay and association with false diagnoses and unnecessary interventions. It remains unclear, whether atypical presentations, misinterpreted symptoms or inconclusive diagnostics are the cause. The aim of this study was the characterization of typical and atypical features of achalasia and their impact on delays, misinterpretations or false diagnoses. A retrospective analysis of prospective database over a period of 30\u00a0years was performed. Data about symptoms, delays and false diagnoses were obtained and correlated with manometric, endoscopic and radiologic findings. Totally, 300 patients with achalasia were included. Typical symptoms (dysphagia, regurgitation, weight loss and retrosternal pain) were present in 98.7%, 88%, 58.4% and 52.4%. The mean diagnostic delay was 4.7\u00a0years. Atypical symptoms were found in 61.7% and led to a delay of 6\u00a0months. Atypical gastrointestinal symptoms were common (43%), mostly \u2018heartburn\u2019 (16.3%), \u2018vomiting\u2019 (15.3%) or belching (7.7%). A single false diagnosis occurred in 26%, multiple in 16%. Major gastrointestinal misdiagnoses were GERD in 16.7% and eosinophilic esophagitis in 4%. Other false diagnosis affected ENT-, psychiatric, neurologic, cardiologic or thyroid diseases. Pitfalls were the description of \u2018heartburn\u2019 or \u2018nausea\u2019. Tertiary contractions at barium swallows, hiatal hernias and \u2018reflux-like\u2019 changes at endoscopy or eosinophils in the biopsies were misleading. Atypical symptoms are common in achalasia, but they are not the sole source for diagnostic delays. Misleading descriptions of typical symptoms or misinterpretation of diagnostic studies contribute to false diagnoses and delays.<\/jats:p>","DOI":"10.1093\/dote\/doad029","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T18:57:39Z","timestamp":1683745059000},"source":"Crossref","is-referenced-by-count":18,"title":["Atypical presentations and pitfalls of achalasia"],"prefix":"10.1093","volume":"36","author":[{"given":"M","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, University Hospital Giessen and Marburg , Marburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"F\u00f6rschler","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, St. Josefs-Hospital , Wiesbaden , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Wehrmann","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, DKD Helios Klinik Wiesbaden , Wiesbaden , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Marini","sequence":"additional","affiliation":[{"name":"Institute of Medical Biostatistics , Epidemiology and Informatics (IMBEI), Division Biostatistics and Bioinformatics, , Mainz , Germany"},{"name":"University Medical Center Johannes Gutenberg University , Epidemiology and Informatics (IMBEI), Division Biostatistics and Bioinformatics, , Mainz , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Gockel","sequence":"additional","affiliation":[{"name":"Department of Visceral , Transplant, Thoracic and Vascular Surgery, , Leipzig , Germany"},{"name":"University Medical Center of Leipzig , Transplant, Thoracic and Vascular Surgery, , Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A J","family":"Eckardt","sequence":"additional","affiliation":[{"name":"Department of 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