Achalasia: incidence, prevalence and survival. A population‐based study

Sadowski, Daniel C.; Ackah, Fred; Jiang, Bei; Svenson, Larry

doi:10.1111/j.1365-2982.2010.01511.x

Cited by 332 publications

(225 citation statements)

References 26 publications

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“…Sample size for eNOS 27-bp VNTR polymorphism was calculated according to the following parameters: significance level (2-tailed) 0.05, odds ratio (OR) 2.0, power of the study 80% and ratio of case to control equal to 1:2; proportion of population expected to have achalasia based on previous study of 0.01% and proportion of control expected to have eNOS "4a" variant allele frequency of 23% as reported from India. 13,25 The sample size was estimated to be 183 patients and 366 controls. Sample size for iNOS gene G/A-37498 polymorphism was calculated keeping all the above-mentioned parameters same and variant "A" allele frequency of 41% among controls as reported from France.…”

Section: Study Participantsmentioning

confidence: 99%

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

Singh

Ghoshal

Misra

et al. 2015

J Neurogastroenterol Motil

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Background/AimsAchalasia is known to result from degeneration of inhibitory neurons, which are mostly nitrinergic. Characteristic features of achalasia include incomplete lower esophageal sphincter (LES) relaxation and esophageal aperistalsis. Nitric oxide (NO), produced by NO synthase (NOS), plays an important role in peristalsis and LES relaxation. Therefore, we evaluated genetic polymorphisms of NOS gene isoforms (endothelial NOS [eNOS], inducible NOS [iNOS], and neuronal NOS [nNOS]) in patients with achalasia and healthy subjects (HS). MethodsConsecutive patients with achalasia (diagnosed using esophageal manometry) and HS were genotyped for 27-base pair (bp) eNOS variable number of tandem repeats (VNTR), iNOS22G/A (rs1060826), nNOS C/T (rs2682826) polymorphisms by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP), respectively. Results Among ConclusionsAchalasia is associated with eNOS4a4a, iNOS22GA, and nNOS29TT genotypes. This may suggest that polymorphisms of eNOS, iNOS, and nNOS genes are risk factors for achalasia.

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Section: Study Participantsmentioning

confidence: 99%

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

Singh

Ghoshal

Misra

et al. 2015

J Neurogastroenterol Motil

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“…As with the mucosal incision site, we anticipate manometry findings to guide us in determining which patients would not require such a long myotomy (i.e., a patient with non-spastic achalasia). We tend to perform a full-thickness myotomy of the LES (Figure 6) because (1) we are concerned about relief of dysphagia; (2) the residual longitudinal layer seems flimsy and is easily disrupted after the circular muscle is resected; and (3) the longitudinal layer usually plays a lesser role in the barrier mechanism. Most POEM operators perform only a partial LES myotomy leaving the outer longitudinal muscle layer intact, but one group transitioned to a full-thickness myotomy and reported significant better esophageal emptying in treated patients after the transition [28] .…”

Section: Lower Esophageal Myotomy: Orientation Depth and Lengthmentioning

confidence: 99%

“…Achalasia is noted equally in both genders with prevalence that ranges up to 1 per 10000 persons and it occurs across the age span, though diagnosis is usually made in middle age or later [1] . The majority of cases are idiopathic, but the syndrome can be associated with malignancy (especially involving the gastro-esophageal junction) and as a part of the spectrum of Chagas disease.…”

Section: Introductionmentioning

confidence: 99%

Per-oral endoscopic myotomy for achalasia: An American perspective

Friedel

Modayil²,

Iqbal³

et al. 2013

WJGE

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Achalasia is an uncommon esophageal motility disorder characterized by the selective loss of enteric neurons leading to absence of peristalsis and impaired relaxation of the lower esophageal sphincter. Per-oral endoscopic myotomy (POEM) is a novel modality for the treatment of achalasia performed by gastroenterologists and surgeons. It represents a natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy. POEM has the minimal invasiveness of an endoscopic procedure that can duplicate results of the surgical Heller myotomy. POEM is conceptually similar to a surgical myotomy without the inherent external incisions and post-operative care associated with surgery. Initial high success and low complications rates promise a great future for this technique. In fact, POEM has been successfully performed on patients with end-stage achalasia as an initial treatment reserving esophagectomy for those without good response. The volume of POEMs performed worldwide has grown exponentially. In fact, surgeons who have performed Heller myotomy have embraced POEM as the preferred intervention for achalasia. However, the niche of POEM remains to be defined and long term results are awaited. We describe our experience with POEM having performed the first POEM outside of Japan in 2009, the evolution of our technique, and give our perspective on its future. Key words: Per-oral endoscopic myotomy; Achalasia; Heller myotomy; Natural orifice transluminal endoscopic surgery; Per-oral endoscopic myotomy; Minimally invasive surgery Core tip: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure that duplicates results of the surgical Heller myotomy. This innovative technique has been performed by both gastroenterologists and surgeons. POEM has been shown to be safe and effective in patients with classic achalasia and modest follow-up data. POEM has also been successfully applied in patients with hypertensive esophageal motor disorders as well as end-stage achalasia. It is recommended that prior to performing POEM, operators should have experience in endoscopic submucosal dissection or substantial training in animal models.

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“…The reported incidence of achalasia varies between 0.03 per 100 000 in a Zimbabwean population,1 1.07 per 100 000 in Chicago in the USA2 and 1.63 per 100 000 in Canada 3. However, these studies included small cohorts of only 25, 379 and 463 subjects with achalasia, respectively.…”

Section: Introductionmentioning

confidence: 99%

Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data

Harvey

Thomas

Chandan

et al. 2018

Gut

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The incidence of achalasia is 1.99 per 100 000 population in secondary care data and 1.53 per 100 000 person-years in primary care data. Subjects with achalasia have an increased incidence of oesophageal cancer, aspiration pneumonia, lower respiratory tract infections and higher mortality. Clinicians treating patients with achalasia should be made aware of these associated morbidities and its increased mortality.

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Achalasia: incidence, prevalence and survival. A population‐based study

Abstract: Using a population-based approach, the incidence and prevalence of treated achalasia is 1.63/100,000 and 10.82/100,000, respectively. The disease appears to have a stable incidence but a rising prevalence. Survival of achalasia cases is significantly less than age-matched healthy controls.

Cited by 332 publications

References 26 publications

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

Per-oral endoscopic myotomy for achalasia: An American perspective

Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data

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