Epidemiology and practice patterns of achalasia in a large multi-centre database

Abstract

Background and Aims Because of its rarity, achalasia remains a difficult disease to study. The aim of the present analysis was to describe the epidemiology of achalasia and practice patterns in its endoscopic management, utilizing patient records from a large national database of endoscopic procedures. Methods The Clinical Outcomes Research Initiative (CORI) maintains a database of endoscopic procedures in diverse clinical practices. The data from 89 endoscopy practices distributed throughout the US during 2000–2008 were used to analyze the characteristics and therapy of patients with achalasia. Results Among 521,497 upper endoscopies during the study period, we identified 896 patients with achalasia. Compared with the entirety of all other endoscopic diagnoses, achalasia was more common in men than women (OR=1.39, CI 1.22–1.59), but similar among non-whites and whites (OR=0.87, CI 0.74–1.03). Relatively more achalasia patients were treated at university than community practices (OR=1.52, CI 1.30–1.78). Botox injection was most frequently used as first choice of endoscopic therapy in 41%, followed by balloon dilation in 21%, Savary dilation in 20%, Maloney dilation in 10%, Rigiflex in 4%, and other modalities in 4% of patients. One quarter of achalasia patients treated endoscopically underwent a repeat therapy about every 14 months. Conclusions Botox has become the primary choice of initial endoscopic therapy in achalasia. Despite their partial deviation from guidelines and recommendations, these endoscopic patterns reflect the current clinical practice in the United States.

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

“…The data provided by HES have been validated, demonstrating high levels of agreement in an individual provider. Data completeness can also supported by comparison of the median age with other studies including Samo (median age 56 years)2 and Enestvedt (mean age 62 years)18compared with 59 in HES and 62 in THIN. Unfortunately, oesophageal manometry data were not available within HES or THIN to support the coded diagnosis of achalasia.…”

Therapeutic options in oesophageal dysphagia

“…19 Because of its simplicity, injection of this agent gained rapid acceptance as a treatment for achalasia, and, surprisingly, it was found to be the most commonly used initial therapy by US gastroenterologists according to a 2011 survey. 20 Injection schemes show major variations, ranging between 50 and 200 international units delivered at the cardia or also in the segment above. 21 However, the therapeutic effect of botulinium toxin wears off quickly in many patients: a meta-analysis found symptomatic response rates after a single injection of 78.7% at 1 month, 70% at 3 months, 53.3% at 6 months, and 40.6% at 12 months.…”

Esophageal motility disorder achalasia

“…It is a neurotoxin that blocks the release of acetylcholine from the nerve terminals. In a recent review of US practice patterns of achalasia [19], botulinum toxin was the initial treatment in 41% of achalasia patients followed by balloon dilation in 21%. There are five commercial formulations of botulinum toxins with varying potencies.…”