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

Harvey, Philip; Thomas, Tom; Chandan, Joht Singh; Mytton, Jemma; Coupland, Ben; Bhala, Neeraj; Evison, Felicity; Patel, Prashant; Nirantharakumar, Krishnarajah; Trudgill, Nigel

doi:10.1136/gutjnl-2018-316089

Cited by 41 publications

(38 citation statements)

References 18 publications

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“…1 The annual incidence is approximately 2 to 3 per 100,000 people, and prevalence is 10 per 100,000 people. [2][3][4][5] Patients have an increased incidence of oesophageal cancer, aspiration pneumonia, lower respiratory tract infections, and higher mortality. 3 Presentation is variable, but more than 90% of patients report dysphagia to both solids and liquids, and more than three-quarters experience regurgitation of undigested food.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Mundre

Black

Mohammed

et al. 2021

The Lancet Gastroenterology & Hepatology

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Section: Introductionmentioning

confidence: 99%

Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Mundre

Black

Mohammed

et al. 2021

The Lancet Gastroenterology & Hepatology

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“…This condition can start at any time of life but is more common in middle‐aged or older adults 1 . It is equally prevalent in males and females, with an overall incidence of 1.63 cases per 100 000 people 2,3 . The underlying causes of achalasia are unknown 1 .…”

Section: Introductionmentioning

confidence: 99%

Mapping the experiences of people with achalasia from initial symptoms to long‐term management

Kalantari

Hollywood

Lim

et al. 2020

Health Expectations

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Background Achalasia is a rare motility disorder affecting the oesophagus, which is associated with a range of symptoms and different treatment strategies. Currently, little is known about people's experiences with achalasia and its management. This study aimed to understand the experiences of people living with achalasia, from the initial onset of symptoms to long‐term management. Method This qualitative study explored the journey of people living with achalasia and outlined the care pathway using a process map. Ten female and five male participants living with achalasia (age range: 40‐73) took part, and all aspects of their diagnosis, treatment and management were discussed. A process map showing people's experiences by separating the management of their condition into a series of steps was developed to present the pathway in the participants’ journey. The analysis involved discussing the process map within the research team. Results The process map comprised of 10 steps, which occurred before and after diagnosis. The developed map indicates that most participants managed their on‐going symptoms through stress management techniques and dietary changes. Key issues that participants highlighted about their journey managing achalasia were misdiagnosis, delay in diagnosis and lack of support in the long‐term management of achalasia. Conclusions This research was a novel study exploring patients’ experiences and management of achalasia and mapping their journey. Two distinct phases to their journeys were identified: before and after diagnosis. Areas highlighted by this study can provide a basis for future research, in particular behaviour change to support the long‐term management of achalasia.

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“…For IgA vasculitis we identified patients with the child onset and adult onset IgA vasculitis and identified following adjustment that these patients had an increased risk of developing hypertension (Child onset: HR 1.52; 95% CI 1.22-1.89; Adult onset: HR 1.42; 95% CI 1.19-1.70) and chronic kidney disease (Child: HR 1.89; 95% CI 1.16-3.07; Adult: HR 1.54; 95% CI 1.23-1.93) [41]. With a similar study design, we identified that the diagnosis of the oesophageal condition achalasia was strongly associated with the development of oesophageal cancer and lower respiratory tract infections [15]. The findings in both of these studies are useful to clinicians as we can shed light on novel associations which are important to consider in clinical management and long-term surveillance.…”

Section: Utility and Validity Of Dextermentioning

confidence: 65%

“…We have conducted similar retrospective cohort study designs to report on outcomes including for rare diseases such as Achalasia [15] and IgA vasculitis [41]. For IgA vasculitis we identified patients with the child onset and adult onset IgA vasculitis and identified following adjustment that these patients had an increased risk of developing hypertension (Child onset: HR 1.52; 95% CI 1.22-1.89; Adult onset: HR 1.42; 95% CI 1.19-1.70) and chronic kidney disease (Child: HR 1.89; 95% CI 1.16-3.07; Adult: HR 1.54; 95% CI 1.23-1.93) [41].…”

Section: Utility and Validity Of Dextermentioning

confidence: 99%

“…However, the strength of these databases lies in their size, breadth, representativeness of the population, long-term follow-up and sufficient data quality. Primary care databases offer great research potential related to drug safety and effectiveness research, identification of disease risk factors, generation of algorithms for identification of high risk patients, evaluation of public health policies and surveillance of diseases [4,[12][13][14][15][16]. In recent years, there is an increase in trend of using such routinely available data in healthcare research [3,17].…”

Section: Introductionmentioning

confidence: 99%

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Data extraction for epidemiological research (DExtER): a novel tool for automated clinical epidemiology studies

et al. 2020

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The use of primary care electronic health records for research is abundant. The benefits gained from utilising such records lies in their size, longitudinal data collection and data quality. However, the use of such data to undertake high quality epidemiological studies, can lead to significant challenges particularly in dealing with misclassification, variation in coding and the significant effort required to pre-process the data in a meaningful format for statistical analysis. In this paper, we describe a methodology to aid with the extraction and processing of such databases, delivered by a novel software programme; the "Data extraction for epidemiological research" (DExtER). The basis of DExtER relies on principles of extract, transform and load processes. The tool initially provides the ability for the healthcare dataset to be extracted, then transformed in a format whereby data is normalised, converted and reformatted. DExtER has a user interface designed to obtain data extracts specific to each research question and observational study design. There are facilities to input the requirements for; eligible study period, definition of exposed and unexposed groups, outcome measures and important baseline covariates. To date the tool has been utilised and validated in a multitude of settings. There have been over 35 peer-reviewed publications using the tool, and DExtER has been implemented as a validated public health surveillance tool for obtaining accurate statistics on epidemiology of key morbidities. Future direction of this work will be the application of the framework to linked as well as international datasets and the development of standardised methods for conducting electronic pre-processing and extraction from datasets for research purposes.

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

Cited by 41 publications

References 18 publications

Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Mapping the experiences of people with achalasia from initial symptoms to long‐term management

Data extraction for epidemiological research (DExtER): a novel tool for automated clinical epidemiology studies

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