Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Gut. 2019 May;68(5):790-795. doi: 10.1136/gutjnl-2018-316089. Epub 2018 Jun 20.
Achalasia is an uncommon condition characterised by failed lower oesophageal sphincter relaxation. Data regarding its incidence, prevalence, disease associations and long-term outcomes are very limited.
Hospital Episode Statistics (HES) include demographic and diagnostic data for all English hospital attendances. The Health Improvement Network (THIN) includes the primary care records of 4.5 million UK subjects, representative of national demographics. Both were searched for incident cases between 2006 and 2016 and THIN for prevalent cases. Subjects with achalasia in THIN were compared with age, sex, deprivation tand smoking status matched controls for important comorbidities and mortality.
There were 10 509 and 711 new achalasia diagnoses identified in HES and THIN, respectively. The mean incidence per 100 000 people in HES was 1.99 (95% CI 1.87 to 2.11) and 1.53 (1.42 to 1.64) per 100 000 person-years in THIN. The prevalence in THIN was 27.1 (25.4 to 28.9) per 100 000 population. Incidence rate ratios (IRRs) were significantly higher in subjects with achalasia (n=2369) compared with controls (n=3865) for: oesophageal cancer (IRR 5.22 (95% CI: 1.88 to 14.45), p<0.001), aspiration pneumonia (13.38 (1.66 to 107.79), p=0.015), lower respiratory tract infection (1.33 (1.05 to 1.70), p=0.02) and mortality (1.33 (1.17 to 1.51), p<0.001). The median time from achalasia diagnosis to oesophageal cancer diagnosis was 15.5 (IQR 20.4) years.
The incidence of achalasia is 1.99 per 100 000 population in secondary care data and 1.53 per 100 000 person-years in primary care data. Subjects with achalasia have an increased incidence of oesophageal cancer, aspiration pneumonia, lower respiratory tract infections and higher mortality. Clinicians treating patients with achalasia should be made aware of these associated morbidities and its increased mortality.
贲门失弛缓症是一种少见的疾病，其特征为下食管括约肌松弛失败。关于其发病率、患病率、疾病关联和长期结果的数据非常有限。
医院入院统计数据（HES）包括所有英国住院患者的人口统计学和诊断数据。健康改进网络（THIN）包括 450 万英国受试者的初级保健记录，代表全国人口统计学。这两个数据库都在 2006 年至 2016 年间搜索了新发病例，而 THIN 则用于搜索现患病例。THIN 中贲门失弛缓症患者与年龄、性别、贫困和吸烟状况匹配的对照组进行比较，以评估重要的合并症和死亡率。
HES 和 THIN 中分别有 10509 例和 711 例新贲门失弛缓症诊断。HES 中每 100000 人平均发病率为 1.99（95%CI 1.87 至 2.11），THIN 中每 100000 人年发病率为 1.53（1.42 至 1.64）。THIN 中的患病率为每 100000 人 27.1（25.4 至 28.9）。与对照组（n=3865）相比，贲门失弛缓症患者（n=2369）的癌症（食管）发病率比（IRR）显著更高（5.22（95%CI：1.88 至 14.45），p<0.001）、吸入性肺炎（13.38（1.66 至 107.79），p=0.015）、下呼吸道感染（1.33（1.05 至 1.70），p=0.02）和死亡率（1.33（1.17 至 1.51），p<0.001）。从贲门失弛缓症诊断到食管癌诊断的中位时间为 15.5（IQR 20.4）年。
在二级保健数据中，贲门失弛缓症的发病率为每 100000 人 1.99，在初级保健数据中为每 100000 人年 1.53。贲门失弛缓症患者的食管癌、吸入性肺炎、下呼吸道感染发病率增加，死亡率更高。治疗贲门失弛缓症患者的临床医生应意识到这些相关的合并症及其增加的死亡率。
