Epidemiology of hospitalization for achalasia in the United States

Abstract

Achalasia is an uncommon esophageal motility disorder of unknown etiology. To gain insights into possible etiologic risk factors, demographic and comorbidity data were obtained from Medicare hospital discharge data files from 1986-1989 on patients aged 65 and older. Age-adjusted sex- and race-specific occurrence rates were calculated for each US state. The rate of comorbid illness occurrence in achalasia patients was compared to that of the entire hospitalized Medicare population. Records of 15,000 achalasia discharges were available for analysis. Achalasia discharge rates increased linearly from age 65 to 94 years. They were similar in males and females as well as whites and nonwhites. High rates were observed in the South and low rates in most states of the East North Central region around the Great Lakes and in the Pacific region. The same geographic pattern was observed in men and women as well as in the two separate subsets of data representing the periods 1986-1987 and 1988-1989. Achalasia was associated with a significantly increased risk for pulmonary complications, malnutrition, and gastroesophageal cancer. The concordant occurrence of achalasia in patients with Parkinson's disease, depressive disorder, and various other myoneural disorders indicated a possible etiologic relationship. Achalasia appears to represent the clinical end point of several different pathways. Besides aging, different neurologic diseases may contribute to a loss in control of esophageal motility. The geographic pattern could suggest the influence of environmental factors.

Achalasia: What’s New in Diagnosis and Treatment?

“…An epidemiologic study from the United States suggested that achalasia was associated with various neurological and psychiatric dis orders, such as Parkinson's disease and de pression [11]. Case reports have associated achalasia with neurologic disorders such as hereditary cerebellar ataxia and von Reck linghausen's neurofibromatosis [23.…”

“…Epidemiologic studies demonstrate geo graphic variations in the prevalence of achala sia which might be due to an unknown envi ronmental factor(s) [10,11,29], Implicated factors include bacteria (diphtheria pertussis, Clostridia. TB and syphilis), viruses (herpes varicella zoster, polio and measles), toxic agents (combat gas), esophageal trauma and ischemic esophageal damage in utero during gut rotation [29][30][31][32][33][34][35].…”

“…Men and women are equally affected [4,11] . Caucasians arc reported by some to be affected more commonly than Blacks, al though there was no difference between Blacks and Caucasians in the Medicare popu lation [11,20].…”

“…10] . According to Medicare hospital discharge files, 3,500 cases were diagnosed annually among Medicare beneficiaries [11]. Over a 20-year period , 421 patients with primary achalasia were diagnosed at the Cleveland Clinic, i.e., 1.8 patients/month on average [12], Achalasia typically occurs in adults be tween the ages of 25 and 60 years [4,13,14].…”

“…Less than 5% of cases occur in children <15 years of age [ 15], Many of the childhood cases have associated anomalies such as adrenocorticotrophic hormone insensitivity, alacrima, autonomic and motor neuropathy, short stat ure, microcephaly and nerve deafness [16][17][18][19]. Men and women are equally affected [4,11] . Caucasians arc reported by some to be affected more commonly than Blacks, al though there was no difference between Blacks and Caucasians in the Medicare popu lation [11,20].…”