Risk factors for diagnostic delay in achalasia.

This study investigates whether the frequently delayed diagnosis of achalasia is attributable to atypical symptoms, misleading diagnostic features, or the number of physicians consulted. Eighty-seven consecutive patients with newly diagnosed achalasia were prospectively investigated with the use of structured interviews as well as manometric, endoscopic, and radiographic studies. The mean duration of symptoms was 4.7 +/- 6.4 years. Quality and intensity of symptoms had no effect on early diagnosis. Among different radiographic and manometric features, only the width of the gastric cardia showed a significant correlation with a delay in diagnosis (P < 0.01). However, the most significant association was found between the duration of symptoms prior to considering the diagnosis of achalasia and the number of unsuccessful physician consultations (P = 0.001). We conclude that the frequent delay in the diagnosis of achalasia is not due to an atypical clinical presentation of this disease but rather to misinterpretation of typical findings by the physician consulted.