Rosenzweig S, Traube M
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06510.
J Clin Gastroenterol. 1989 Apr;11(2):147-53. doi: 10.1097/00004836-198904000-00007.
An impression that achalasia remains an elusive diagnosis led us to review our recent experience. From August 1, 1985 to March 31, 1987, we saw 25 patients with "previously untreated" achalasia for consultation and/or treatment. Data was extracted from review of their records. Achalasia was the initial diagnosis in only 12 patients. The others were given diagnoses of gastroesophageal reflux (4), presbyesophagus (2), esophageal spasm (2), psychiatric disorders (2), and combination of various disorders (3). In the latter patients, various diagnostic studies were either inappropriately delayed or misinterpreted, so that incorrect diagnoses were given. Errors in diagnosis led to further inappropriate testing and therapies. We conclude that: (a) achalasia remains an elusive diagnosis in current practice, (b) errors in diagnosis are related to delay in obtaining appropriate studies or misinterpretation of such studies, and (c) this delay leads to persistent symptoms and ineffective and/or inappropriate therapies.
贲门失弛缓症仍然难以诊断，这种印象促使我们回顾近期的经验。1985年8月1日至1987年3月31日，我们接待了25例“未经治疗”的贲门失弛缓症患者进行咨询和/或治疗。数据来自对他们病历的回顾。仅12例患者最初诊断为贲门失弛缓症。其他患者被诊断为胃食管反流（4例）、老年性食管（2例）、食管痉挛（2例）、精神障碍（2例）以及多种疾病组合（3例）。在后者中，各种诊断性检查要么被不适当地延迟，要么被错误解读，从而给出了错误诊断。诊断错误导致了进一步不适当的检查和治疗。我们得出结论：（a）在当前实践中贲门失弛缓症仍然难以诊断；（b）诊断错误与获得适当检查的延迟或对此类检查的错误解读有关；（c）这种延迟导致症状持续以及治疗无效和/或不适当。
