Reviewer ’s report  
 
Title: Case report: An aortic aneurysm as cause of pseudoachalasia  
 
Version: 1 Date: 24 Jun 2019  
 
Reviewer: Ping-Huei Tseng  
 
Reviewer's report:  
 
The authors reported a case of a 84 -year- old woman with anorexia, dysphagia and unintentional 
weight loss initially diagnosed as achalasia but later was found to have the diagnosis of 
pseudoachalasia due to an aortic aneurysm. Such case is rare but the reviewer has the following 
comments and suggesti ons: 
 
1. From the CT scan, the vascular compression seemed to be located at the middle and 
lower esophagus, rather than the EGJ. Could the chronic aortic aneurysm be an incidental 
finding in a patient with true achalasia?  
 
2. What is the complete data of th e high resolution manometry, such as LES resting 
pressure and IRP -4s? The high pressure zone of LES was relatively thin and thus less 
likely to be compressed by the aorta aneurysm.  
 
3. How did the endoscopy look like? Please show the endoscopic pictures.  
 
4. It would be more informative to show more CT figures, such as sagittal and cross -
sectional view.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of com peting interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either no w or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relat ing to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests ? 
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I  have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understan d that my name wil l be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand t hat any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Case report: An aortic aneurysm as cause of pseudoachalasia  
 
Version: 1 Date: 24 Jun 2019  
 
Reviewer: Ping-Huei Tseng  
 
Reviewer's report:  
 
The authors reported a case of a 84 -year- old woman with anorexia, dysphagia and unintentional 
weight loss initially diagnosed as achalasia but later was found to have the diagnosis of 
pseudoachalasia due to an aortic aneurysm. Such case is rare but the reviewer has the following 
comments and suggesti ons: 
 
1. From the CT scan, the vascular compression seemed to be located at the middle and 
lower esophagus, rather than the EGJ. Could the chronic aortic aneurysm be an incidental 
finding in a patient with true achalasia?  
 
2. What is the complete data of th e high resolution manometry, such as LES resting 
pressure and IRP -4s? The high pressure zone of LES was relatively thin and thus less 
likely to be compressed by the aorta aneurysm.  
 
3. How did the endoscopy look like? Please show the endoscopic pictures.  
 
4. It would be more informative to show more CT figures, such as sagittal and cross -
sectional view.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of com peting interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either no w or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relat ing to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests ? 
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I  have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understan d that my name wil l be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand t hat any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Case report: An aortic aneurysm as cause of pseudoachalasia  
 
Version: 1 Date: 24 Jun 2019  
 
Reviewer: Ping-Huei Tseng  
 
Reviewer's report:  
 
The authors reported a case of a 84 -year- old woman with anorexia, dysphagia and unintentional 
weight loss initially diagnosed as achalasia but later was found to have the diagnosis of 
pseudoachalasia due to an aortic aneurysm. Such case is rare but the reviewer has the following 
comments and suggesti ons: 
 
1. From the CT scan, the vascular compression seemed to be located at the middle and 
lower esophagus, rather than the EGJ. Could the chronic aortic aneurysm be an incidental 
finding in a patient with true achalasia?  
 
2. What is the complete data of th e high resolution manometry, such as LES resting 
pressure and IRP -4s? The high pressure zone of LES was relatively thin and thus less 
likely to be compressed by the aorta aneurysm.  
 
3. How did the endoscopy look like? Please show the endoscopic pictures.  
 
4. It would be more informative to show more CT figures, such as sagittal and cross -
sectional view.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of com peting interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either no w or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relat ing to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests ? 
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I  have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understan d that my name wil l be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand t hat any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant