Risk of Esophageal Adenocarcinoma in Achalasia Patients, a Retrospective Cohort Study in Sweden

Zendehdel, Kazem; Nyrén, Olof; Edberg, Annika; Ye, Weimin

doi:10.1038/ajg.2010.449

Cited by 104 publications

(45 citation statements)

References 20 publications

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“…This is particularly important as regards acute pancreatitis due to the difficulties in establishing the diagnosis of acute pancreatitis highlighted earlier in this article. We found the Patient Register to be reliable with regard to the diagnosis of acute pancreatitis, well in accordance with previous studies validating the Swedish National Patient Register [15,16,17,18]. …”

Section: Discussionsupporting

confidence: 72%

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Reliability of Acute Pancreatitis Diagnosis Coding in a National Patient Register: A Validation Study in Sweden

Razavi

Ljung

et al. 2011

Pancreatology

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Section: Discussionsupporting

confidence: 72%

“…All data are connected to a unique personal identity number given to every Swedish citizen, enabling cross-linkage with a range of national registers [13,14]. The Register has previously been validated to be of good reliability for the diagnoses Guillain-Barré syndrome [15], schizophrenia [16], ischemic heart disease [17], and achalasia [18]. …”

Section: Methodsmentioning

confidence: 99%

Reliability of Acute Pancreatitis Diagnosis Coding in a National Patient Register: A Validation Study in Sweden

Razavi

Ljung

et al. 2011

Pancreatology

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“…Achalasia is associated with an increased incidence of esophageal carcinoma [42-44]. The reason is not clear.…”

Section: Discussionmentioning

confidence: 99%

Mechano‐transcription of COX‐2 is a common response to lumen dilation of the rat gastrointestinal tract

Lin

Shi

2012

Neurogastroenterology Motil

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Background In obstructive bowel disorders (OBDs) such as achalasia, pyloric stenosis, and bowel obstruction, the lumen of the affected segments is markedly dilated and the motility function is significantly impaired. We tested the hypothesis that mechanical stress in lumen dilation leads to induction of cyclooxygenase‐2 (COX‐2) in smooth muscle throughout the gastrointestinal (GI) tract, contributing to motility dysfunction. Methods Lumen dilation was induced in vivo with obstruction bands (12 × 3 mm) applied over the lower esophageal sphincter (LES), the pyloric sphincter, and the ileum in rats for 48 h. Mechanical stretch in vivo was also emulated by balloon distension of the distal colon. Direct stretch of muscle strips from the esophagus, gastric fundus, and ileum was mimicked in an in vitro tissue culture system. Key Results Partial obstruction in the LES, pylorus, and ileum significantly increased the expression of COX‐2 mRNA and protein in the muscularis externae of the dilated segment oral to the occlusions, but not in the aboral segment. Direct stretch of the lumen in vivo or of muscle strips in vitro markedly induced COX‐2 expression. The smooth muscle contractility was significantly suppressed in the balloon‐distended segments. However, treatment with COX‐2 inhibitor NS‐398 restored the contractility. Furthermore, in vivo administration of NS‐398 in gastric outlet obstruction significantly improved gastric emptying. Conclusions & Inferences Mechanical dilation of the gut lumen by occlusion or direct distension induces gene expression of COX‐2 throughout the GI tract. Mechanical stress‐induced COX‐2 contributes to motility dysfunction in conditions with lumen dilation.

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“…77 GERD-related findings range from reflux esophagitis and peptic strictures to Barrett esophagus, which in rare instances may progress to esophageal adeno carcinoma. 77,98 Although the latest American Society of Gastrointestinal Endoscopy guidelines correctly state that there are still "insufficient data to support routine endoscopic (cancer) surveillance for patients with achalasia", 99 overall such an approach might be beneficial if one considers that cancer is not the only late complication of this disease. 100 Most experts, therefore, now favor some form of endoscopic surveillance in patients with achalasia if the disease has been present for more than 10-15 years.…”

Section: Surveillancementioning

confidence: 99%

Treatment and surveillance strategies in achalasia: an update

Eckardt

2011

Nat Rev Gastroenterol Hepatol

148

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Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. Currently, surgical myotomy and pneumatic dilation are the most effective treatments for patients with idiopathic achalasia, and a multicenter, randomized, international trial has confirmed similar efficacy of these treatments, at least in the short term. Clinical predictors of outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and medical therapies are reserved for patients of advanced age and those with clinically significant comorbidites. The value of new endoscopic, radiologic or surgical treatments, such as peroral endoscopic myotomy, esophageal stenting and robotic-assisted myotomy has not been fully established. Finally, long-term follow-up data in patients with achalasia support the notion that surveillance strategies might be beneficial after a disease duration of more than 10-15 years.

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Risk of Esophageal Adenocarcinoma in Achalasia Patients, a Retrospective Cohort Study in Sweden

Abstract: Male achalasia patients have substantially greater risks for both squamous cell carcinoma and adenocarcinoma of the esophagus. Small numbers preclude a firm conclusion about the risk among women.

Cited by 104 publications

References 20 publications

Reliability of Acute Pancreatitis Diagnosis Coding in a National Patient Register: A Validation Study in Sweden

Reliability of Acute Pancreatitis Diagnosis Coding in a National Patient Register: A Validation Study in Sweden

Mechano‐transcription of COX‐2 is a common response to lumen dilation of the rat gastrointestinal tract

Treatment and surveillance strategies in achalasia: an update

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