A recent study, published in the journal Gut, reported incidence and prevalence of achalasia in England that was higher than previously expected. Between 2006 and 2016, achalasia incidence was between 1.42 and 2.11/100,000 and prevalence was 27.1/100,000. Achalasia was found to be associated with 5-fold higher incidence of oesophageal cancer, aspiration pneumonia and lower respiratory tract infection. These findings demonstrate a previously unrecognised increased mortality in patients with achalasia.
Researchers searched Hospital Episode Statistics ([HES], secondary care data) and The Health Improvement Network ([THIN], primary care data) to identify 10,509 and 711 new achalasia diagnosis, respectively. Patients with achalasia were compared with age, sex, deprivation and smoking status matched controls for comorbidities and mortality.
Overall incidence (per 100,000 person-years) of achalasia was 1.99 (95% CI, 1.87-2.11) and 1.53 (95% CI, 1.42-1.64) in HES and THIN, respectively. Achalasia prevalence in THIN was 27.1 (95% CI, 25.4-28.9)/100,000 population. Oesophageal cancer (incident rate ratio [IRR], 5.22; P=.001), aspiration pneumonia (IRR, 13.38; P=.015), lower respiratory tract infection (IRR, 1.33; P=.02) and mortality (IRR, 1.33; P<.001) were more common in patients with achalasia vs control group. Median time from achalasia diagnosis to oesophageal cancer diagnosis was 15.5 (inter quartile range, 5.8-26.2) years.
Authors believe that their findings are crucial for planning therapy for this condition. They urge clinicians to be more vigilant for respiratory tract infections in this patient group. They further add that time to diagnosis of oesophageal cancer should be considered while screening this patient group.
