Pseudoachalasia due to Distal Esophageal Squamous Cell Carcinoma in an Elderly Patient: Clinical Insights

Pseudoachalasia is a rare condition that clinically and radiologically mimics primary achalasia, most commonly secondary to an underlying malignancy. We report the case of a 79-year-old man presenting with a two-month history of progressive dysphagia to both solids and liquids, accompanied by regurgitation, retrosternal discomfort, heartburn, and marked weight loss. Physical examination revealed cachexia and severe muscle wasting. A barium swallow demonstrated esophageal dilatation with a bird-beak appearance, suggestive of achalasia. Upper endoscopy showed nodular, friable mucosa in the distal esophagus with luminal stenosis, while contrast-enhanced CT identified a distal enhancing esophageal lesion. Histopathological examination of the biopsy confirmed a moderately differentiated squamous cell carcinoma. A Stamm gastrostomy was performed to provide enteral nutritional support prior to initiating oncologic management. This case underscores the diagnostic challenge of distinguishing pseudoachalasia from primary achalasia, emphasizing the need to recognize clinical red flags and to pursue targeted diagnostic studies for prompt, cancer-specific treatment.