Division of General Surgery, University Health Network, Toronto, Ontario, Canada.
Dis Esophagus. 2012 Apr;25(3):209-13. doi: 10.1111/j.1442-2050.2011.01249.x. Epub 2011 Sep 7.
Achalasia is a rare disease of the esophagus that has an unknown etiology. Genetic, infectious, and autoimmune mechanisms have each been proposed. Autoimmune diseases often occur in association with one another, either within a single individual or in a family. There have been separate case reports of patients with both achalasia and one or more autoimmune diseases, but no study has yet determined the prevalence of autoimmune diseases in the achalasia population. This paper aims to compare the prevalence of autoimmune disease in patients with esophageal achalasia to the general population. We retrospectively reviewed the charts of 193 achalasia patients who received treatment at Toronto's University Health Network between January 2000 and May 2010 to identify other autoimmune diseases and a number of control conditions. We determined the general population prevalence of autoimmune diseases from published epidemiological studies. The achalasia sample was, on average, 10-15 years older and had slightly more men than the control populations. Compared to the general population, patients with achalasia were 5.4 times more likely to have type I diabetes mellitus (95% confidence interval [CI] 1.5-19), 8.5 times as likely to have hypothyroidism (95% CI 5.0-14), 37 times as likely to have Sjögren's syndrome (95% CI 1.9-205), 43 times as likely to have systemic lupus erythematosus (95% CI 12-154), and 259 times as likely to have uveitis (95% CI 13-1438). Overall, patients with achalasia were 3.6 times more likely to suffer from any autoimmune condition (95% CI 2.5-5.3). Our findings are consistent with the impression that achalasia's etiology has an autoimmune component. Further research is needed to more conclusively define achalasia as an autoimmune disease.
贲门失弛缓症是一种病因不明的食管罕见疾病。遗传、感染和自身免疫机制都曾被提出过。自身免疫性疾病通常相互关联，无论是在单个个体中还是在家族中。已有单独的病例报告显示，患有贲门失弛缓症和一种或多种自身免疫性疾病的患者，但尚无研究确定贲门失弛缓症患者中自身免疫性疾病的患病率。本文旨在比较贲门失弛缓症患者与普通人群中自身免疫性疾病的患病率。我们回顾性分析了 2000 年 1 月至 2010 年 5 月期间在多伦多大学健康网络接受治疗的 193 例贲门失弛缓症患者的病历，以确定其他自身免疫性疾病和一些对照条件。我们从已发表的流行病学研究中确定了自身免疫性疾病的普通人群患病率。贲门失弛缓症样本的平均年龄比对照组大 10-15 岁，且男性略多于对照组。与普通人群相比，贲门失弛缓症患者患 1 型糖尿病的可能性高 5.4 倍（95%置信区间 [CI] 1.5-19），患甲状腺功能减退症的可能性高 8.5 倍（95%CI 5.0-14），患干燥综合征的可能性高 37 倍（95%CI 1.9-205），患系统性红斑狼疮的可能性高 43 倍（95%CI 12-154），患葡萄膜炎的可能性高 259 倍（95%CI 13-1438）。总体而言，贲门失弛缓症患者患任何自身免疫性疾病的可能性高 3.6 倍（95%CI 2.5-5.3）。我们的发现与贲门失弛缓症的病因具有自身免疫成分的印象一致。需要进一步研究才能更明确地将贲门失弛缓症定义为自身免疫性疾病。
