dysphagia in an elderly patient suffering from long-lasting rheumatoid arthritis

Idiopathic esophageal achalasia (iea) is a rare motor disorder whose initial manifestation is dysphagia, sometimes versus liquids. iea can be an uncommon manifestation of some rheumatic inflammatory diseases such as sjogren syndrome, systemic lupus erythematosus, sclerodermia, rheumatoid arthritis. iea is considered a precancerous condition and the possibility that it represents a risk factor for development of esophageal carcinoma (ec) has been more and more descripted. these same rheumatic diseases - when long-standing and/or aggressive - can give an esophageal amyloidosis (ea) with aa amyloid deposits . ea is very rarely descripted as unique manifestation of systemic amyloidosis during these diseases. iea has a typical manometric pattern whereas in ea the anarchic arrangement of amyloid can produce unforeseen and uncharacteristc motility patterns different from the idiopathic one. both iea and ea are very rare conditions. for iea, it has been extimated an annual incidence of 2/100,000 and a prevalence rate of 10/100,000 with a peak incidence between 30 and 60 years of age. the prevalence and incidence of ea are uncertain. the surgical experiences in esophageal pseudoachalasia are aneddhotic. we describe the clinical case of an elderly woman suffering from long-lasting rheumatoid arthritis in which an ea overlapped an iea, causing the sharp worsening of dysphagia and poor prognosis despite surgical approaches. according to our knowledge, this overlap has been never descripted.