Achalasia mimicking psychiatric eating disorders

Anorexia nervosa and psychogen vomiting ore psychiatric eating disorders ch aracterized by unexplained weight loss and induced vomiting. These diagnose s require absence of somatic disease. Achalasia is a primary disorder of th e esophagus that can be responsible for the same symptoms. This may occult the real diagnosis, especially as dysphagia is not constant and variable in time. We report four cases of achalasia mistakenly diagnosed and treated a s anorexia nervosa or psychogen vomiting. Achalasia was unrecognized gbecau se specific symptoms, such as dysphagia, were overlooked or misinterpreted by the patients' physician and psychiatrists, or by the patients themselves . In patients with such earing disorders considered to be psychiatric, phys icians should inquire about signs suggestive of achalasia. The diagnosis of achalasia is suspected by imaging and endoscopy, and confirmed or ruled ou t by manometry.