Sometimes in clinical practice a common disease can hide more complex situation at boundary between gastroenterology, neurology and psychiatry.

We report the case of a 73 years old woman complaining symptoms including belching and suffering from various symptoms that initially brought to diagnoses of Gastroesophageal Reflux Disease (GERD), hypertension and Generalized Anxiety Disorder (GAD).

A common disease such as GAD on the one hand amplifies and exasperates the symptomatology; on the other hand it could result in confusing factors that provoke a delayed diagnosis.

In time, our patient have continued to show collapses, trembles, belching, agitation, weak salivation and severe stypsis that led to further examinations and finally to the diagnosis of Pure Autonomic Failure.

Our case highlights the importance of integrated multidisciplinary approaches to reach a close diagnosis and a correct management of symptoms.

It has to be noticed that there is no case in literature with such a similar clinical presentation for PAF.