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. 2023 Nov 15;17(6):894-904.
doi: 10.5009/gnl220334. Epub 2023 Mar 29.

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

Ga Hee Kim  1 , Hyungchul Park  2   3 , Kee Wook Jung  2 , Min-Ju Kim  4 , Ye-Jee Kim  4 , Ji Min Lee  5 , Bong Eun Lee  6 , Yang Won Min  7 , Jeong Hwan Kim  8 , Hee Kyong Na  2 , Ji Yong Ahn  2 , Jeong Hoon Lee  2 , Do Hoon Kim  2 , Kee Don Choi  2 , Ho June Song  2 , Gin Hyug Lee  2 , Hwoon-Yong Jung  2 , Hyun Jin Kim  9 ; Big Data Study Group Under the Korean Society of Neurogastroenterology and Motility
Affiliations

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

Ga Hee Kim et al. Gut Liver. .

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.

Keywords: Aspiration pneumonia; Esophageal achalasia; Esophageal neoplasms; Esophagus.

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Conflict of interest statement

CONFLICTS OF INTEREST

J.Y.A. and H.J.K. are editorial board members of the journal but were not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Cumulative incidence plot of time from achalasia diagnosis to esophageal cancer and aspiration pneumonia diagnoses. (A) Cumulative incidence plot of time from achalasia diagnosis to esophageal cancer diagnosis. (B) Cumulative incidence plot of time from achalasia diagnosis to aspiration pneumonia diagnosis.
Fig. 2
Fig. 2
Cumulative incidence plot of time from achalasia diagnosis to death. (A) Cumulative incidence of overall death in the control and achalasia groups. (B) Cumulative incidence of cancer-related death in the control and achalasia groups. (C) Cumulative incidence of esophageal cancer-related death in the control and achalasia groups. (D) Cumulative incidence of pneumonia-related death in the control and achalasia groups.
Fig. 2
Fig. 2
Cumulative incidence plot of time from achalasia diagnosis to death. (A) Cumulative incidence of overall death in the control and achalasia groups. (B) Cumulative incidence of cancer-related death in the control and achalasia groups. (C) Cumulative incidence of esophageal cancer-related death in the control and achalasia groups. (D) Cumulative incidence of pneumonia-related death in the control and achalasia groups.
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