Gut Liver.  2023 Nov;17(6):894-904. 10.5009/gnl220334.

Incidence, Morbidity, and Mortality of Achalasia: A Nationwide, Population-Based Cohort Study in South Korea

• Kim GH
• Park H
• Jung KW
• Kim MJ
• Kim YJ
• Lee JM
• Lee BE
• Min YW
• Kim JH
• Na HK
• Ahn JY
• Lee JH
• Kim DH
• Choi KD
• Song HJ
• Lee GH
• Jung HY
• Kim HJ
• Big Data Study Group Under the Korean Society of Neurogastroenterology and Motility

• KMID: 2548448
• DOI: http://doi.org/10.5009/gnl220334

Abstract

Background/Aims
Although an association between achalasia and esophageal cancer has been reported, whether achalasia confers a substantial increase in mortality is unknown. Moreover, the causes of death related to achalasia have not been investigated. We performed this nationwide, population-based cohort study on achalasia because no such study has been performed since the introduction of high-resolution manometry in 2008.
Methods
This study was performed using data extracted from the Korean National Health Insurance Service database, covering a 9-year period from 2009 to 2017. Control participants without a diagnostic code for achalasia were randomly selected and matched by sex and birth year at a case-to-control ratio of 1:4. Data on the cause of death from Statistics Korea were also analyzed.
Results
The overall incidence of achalasia was 0.68 per 100,000 person-years, and the prevalence was 6.46 per 100,000 population. Patients with achalasia (n=3,063) had significantly higher adjusted hazard ratio (aHR) for esophageal cancer (aHR, 3.40; 95% confidence interval [CI], 1.25 to 9.22; p=0.017), pneumonia (aHR, 2.30; 95% CI, 1.89 to 2.81; p<0.001), aspiration pneumonia (aHR, 3.92; 95% CI, 2.38 to 6.48; p<0.001), and mortality (aHR, 1.68; 95% CI, 1.44 to 1.94; p<0.001). Esophageal cancer carried the highest mortality risk (aHR, 8.82; 95% CI, 2.35 to 33.16; p=0.001), while pneumonia had the highest non-cancer mortality risk (aHR, 2.28; 95% CI, 1.31 to 3.96; p=0.004).
Conclusions
In this nationwide study, achalasia was associated with increased risk of mortality. Esophageal cancer and pneumonia were the most common comorbidities and the major causes of death in patients with achalasia.

Keyword

Esophageal achalasia; Esophagus; Aspiration pneumonia; Esophageal neoplasms