Patients with achalasia at risk of oesophageal cancer

Achalasia is associated with an increased risk of developing both squamous cell carcinoma and adenocarcinoma of the oesophagus, reveals a study, noting, however, that the annual incidence of oesophageal cancer is rather low.

The authors carried out a long-term prospective cohort study to assess the risk of both squamous cell carcinoma and adenocarcinoma of the oesophagus in patients with primary achalasia. Between 1973 and 2018, they followed these patients by the same protocol including upper endoscopy with oesophageal biopsies.

Standardized incidence ratios (SIRs) with 95 percent confidence interval (CI) were used to estimate the relative risk of oesophageal cancer in patients with achalasia relative to the sex- and age-matched general population.

Overall, 566 patients with achalasia (mean age at diagnosis, 48.1 years; 46 percent men) were followed for a mean of 15.5 years since diagnosis. Of these, 20 (15 men) developed oesophageal cancer: 15 squamous cell carcinoma and five adenocarcinoma.

Achalasia patients had a significantly higher risk of oesophageal cancer than the general population (SIR, 104.2, 95 percent CI, 63.7–161), both for squamous cell carcinoma (SIR, 126.9, 95 percent CI, 71.0–209.3) and adenocarcinoma (SIR, 110.2, 95 percent CI, 35.8–257.2). Notably, men exhibited a higher risk than women.

Furthermore, the annual incidence rate of oesophageal cancer was only 0.24 percent, which was higher for squamous cell carcinoma (0.18 percent) than adenocarcinoma (0.06 percent).

“These findings may have implications for endoscopic surveillance of patients with achalasia,” the authors said.