Achalasia linked to esophageal cancer risk

People with achalasia, a rare swallowing disorder affecting the esophagus, may be at increased risk of esophageal cancer (EC), suggests a study.

A total of 9,315 individuals (median age 55 years, 92 percent male) were included in the analysis. Of these, 1,863 had achalasia and were matched to 7,452 without achalasia.

Seventeen cases of EC (three esophageal adenocarcinoma, 12 squamous cell carcinoma, and two unknown type) occurred among individuals with achalasia, compared with just 15 EC (11 esophageal adenocarcinoma, one squamous cell carcinoma, and three unknown type) among those without achalasia during a median follow-up of 5.5 years.

The incidence of EC was 1.4 per 1,000 person-years for individuals with achalasia, with a median time from achalasia diagnosis to EC development of 3.0 years. Those with achalasia also showed a higher cumulative EC incidence at 5, 10, and 15 years of follow-up than individuals without achalasia, with almost a fivefold greater risk of RC (hazard ratio, 4.6, 95 percent confidence interval, 2.3‒9.2).

“Based on substantial EC risk, individuals with achalasia may benefit from a high index of suspicion and endoscopic surveillance for EC,” the authors said.

This matched cohort study was carried out on US veterans aged ≥18 years from 1999 to 2019. Individuals with achalasia were age- and sex-matched in a 1:4 ratio to those without achalasia.

The authors conducted follow-up from study entry until diagnosis with incident/fatal EC, death from non-EC-related causes, or end of study (31 December 2019). Cox regression models were used to explore the link between achalasia and EC risk.