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Eur Eat Disord Rev. 2014 Sep;22(5):321-30. doi: 10.1002/erv.2307. Epub 2014 Jul 22.

Is it an eating disorder or achalasia or both? A literature review and diagnostic challenges.

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  • 1Regional Eating Disorders Service, Division of Mental Health and Addiction, Oslo University Hospital, Norway.



Achalasia is a rare oesophageal motility disorder characterized by physical, behavioural and psychosocial features that are strikingly similar to eating disorders (ED).


A literature search of PubMed and Google Scholar identified 36 cases of achalasia from 11 countries misdiagnosed as ED between 1980 and 2013.


On average, the typical misdiagnosed case was an 18-year-old female with an average weight loss of 16.2 kg. Vomiting behaviour in achalasia was distinguished by occurring after both solids and liquids, occurring in public, and worsening at night or while lying down, and was associated with pain relief. Manometric investigations of oesophageal functioning in clinical ED samples are few and have shown little evidence of dysmotility.


Achalasia and ED share numerous clinical features including weight loss and vomiting. Pain associated with swallowing difficulties may lead to an increasingly restricted pattern of eating and food avoidance. Increased awareness of achalasia in ED treatment settings can help facilitate detection of achalasia, thereby reducing treatment delay.

© 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.


achalasia; avoidant/restrictive food intake disorder; eating disorders; gastrointestinal; oesophageal dysmotility

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