Incidence, Morbidity, and Mortality of Achalasia: A Nationwide, Population-Based Cohort Study in South Korea
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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.
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.
참고문헌 (20)
- Vaezi MF, "ACG clinical guidelines : diagnosis and management of achalasia", Am J Gastroenterol, 115, pp.1393~1411 (2020)
- Eckardt AJ, "Treatment and surveillance strategies in achalasia : an update", Nat Rev Gastroenterol Hepatol, 8, pp.311~319 (2011)
- Pandolfino JE, "Achalasia : a systematic review", JAMA, 313, pp.1841~1852 (2015)
- Mayberry JF, "Epidemiology and demographics of achalasia", Gastrointest Endosc Clin N Am, 11, pp.235~247 (2001)
- 김은경, "Achalasia in Korea: An Epidemiologic Study Using a National Healthcare Database", Journal of Korean Medical Science, 29(4), pp.576~580 (2014), 대한의학회
- Lee Jung Min, "The Usefulness of the Measurement of Esophagogastric Junction Distensibility by EndoFLIP in the Diagnosis of Gastroesophageal Reflux Disease", Gut and Liver, 15(4), pp.546~552 (2021), 거트앤리버 소화기연관학회협의회[DOI]
- 정혜경, "2019 Seoul Consensus on Esophageal Achalasia Guidelines", Journal of Neurogastroenterology and Motility (JNM), 26(2), pp.180~203 (2020), 대한소화기 기능성질환∙운동학회[DOI]
- Kim GH, "Superior clinical outcomes of peroral endoscopic myotomy compared with balloon dilation in all achalasia subtypes", J Gastroenterol Hepatol, 34, pp.659~665 (2019)
- Samo S, "Incidence and prevalence of achalasia in central Chicago, 2004-2014, since the widespread use of high-resolution manometry", Clin Gastroenterol Hepatol, 15, pp.366~373 (2017)
- Zendehdel K, "Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden", Am J Gastroenterol, 106, pp.57~61 (2011)
- Sandler RS, "The risk of esophageal cancer in patients with achalasia : a population-based study", JAMA, 274, pp.1359~1362 (1995)
- Harvey PR, "Incidence, morbidity and mortality of patients with achalasia in England : findings from a study of nationwide hospital and primary care data", Gut, 68, pp.790~795 (2019)
- 송선옥, "Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System", Diabetes and Metabolism Journal, 38(5), pp.395~403 (2014), 대한당뇨병학회[DOI]
- Roman S, "High-resolution manometry improves the diagnosis of esophageal motility disorders in patients with dysphagia : a randomized multicenter study", Am J Gastroenterol, 111, pp.372~380 (2016)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Sadowski DC, "Achalasia : incidence, prevalence and survival : a population-based study", Neurogastroenterol Motil, 22, pp.e256~e261 (2010)
- Sato H, "Epidemiological analysis of achalasia in Japan using a large-scale claims database", J Gastroenterol, 54, pp.621~627 (2019)
- Shin A, "Trends in incidence and survival of esophageal cancer in Korea : analysis of the Korea Central Cancer Registry Database", J Gastroenterol Hepatol, 33, pp.1961~1968 (2018)
- Chiam Keng Hoong, "Current Status of Mucosal Imaging with Narrow-Band Imaging in the Esophagus", Gut and Liver, 15(4), pp.492~499 (2021), 거트앤리버 소화기연관학회협의회[DOI]
- Eckardt VF, "Life expectancy, complications, and causes of death in patients with achalasia : results of a 33-year follow-up investigation", Eur J Gastroenterol Hepatol, 20, pp.956~960 (2008)