Epidemiology of achalasia in central israel rarity of esophageal cancer

Abstract

The epidemiology of achalasia was studied in a predominantly urban, Jewish population of approximately 1.3 million, in central Israel, during the years 1973-1983. One hundred sixty-two proven cases were collected, representing all known patients with achalasia in the study area. There were no gender differences. The majority of cases were diagnosed within two years of onset of symptoms, although the median delay in diagnosis was 4.4 +/- 5.3 years. The disease was rare in the first two decades of life. The prevalence (in 1983) in the first two decades was 0.7/10(5) rising to 36.2/10(5) above age 70. The mean annual incidence in the years 1973-1978 was 0.8/10(5). It rose slightly to a mean annual incidence of 1.1/10(5) in the years 1979-1983. The prevalence of the disease in 1973 and 1983 was 7.9/10(5) and 12.6/10(5), respectively. The age-adjusted prevalence in 1973 was higher in Asian and African born Jews as compared to those born in Europe, America, or Israel. This difference disappeared by the year 1983. No case of cancer of the esophagus was found among our patients. This may be due to the nonselected, regional nature of our series or to the effects of earlier therapy of achalasia in recent decades.

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

“…28 The mean delay in diagnosis is 5 years (range, 2-7 years). [29][30][31][32][33][34][35] Howard et al 36 reported that 36.8% of achalasia patients had been treated for GERD. Additionally, Rosenzweig and Traube 9 showed that the initial diagnosis was achalasia in only 12 of out 25 achalasia patients, whereas the other 13 patients were diagnosed incorrectly.…”

Achalasia: What’s New in Diagnosis and Treatment?

“…Achalasia patients may have an increased risk of developing secondary esophageal carci noma [152][153][154], Recent studies involving about 500 achalasia patients suggested that the prevalence of squamous cell carcinoma was rare (1 case or 0.2%), however the follow up was only 3.6-6.0 years [4,155,156], Another prospective study involving about 200 achalasia patients followed for at least 10 years found a 33-fold increase in esophageal squamous cell carcinoma compared to con trols with a yearly incidence rate of 3.4/1,000 [157], Patients at risk were elderly, had a long history of dysphagia, and the esophagus was markedly dilated. Whether screening for esophageal cancer in the achalasia population is cost-effective is unknown, but we do sur veillance endoscopy every 3-5 years in clini cally appropriate patients [ 157].…”

“…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].…”

“…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].…”

Laparoscopic Heller Myotomy for Achalasia Cardia—Initial Experience in a Teaching Institute

“…Due to the slow progress of the disease, the symptoms are often confused with gastroesophageal reflux disease or simple dyspepsia and treated accordingly. Arber reported a delay of 4.4 years in his series, attributing it to the rarity of the disease [5]. All treatments for achalasia aim to alleviate symptoms, although no treatment reverses the underlying neuropathological changes or associated impaired lower esophageal sphincter (LES) relaxation and aperistalsis.…”