Type II Achalasia Is Increasing in Prevalence

  • PDF / 688,511 Bytes
  • 5 Pages / 595.276 x 790.866 pts Page_size
  • 43 Downloads / 193 Views

DOWNLOAD

REPORT


ORIGINAL ARTICLE

Type II Achalasia Is Increasing in Prevalence Margaret J. Zhou1 · Afrin Kamal2 · Daniel E. Freedberg1 · David Markowitz1 · John O. Clarke2 · Daniela Jodorkovsky1  Received: 3 July 2020 / Accepted: 8 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Background  Three manometric subtypes of achalasia were defined in the Chicago Classification approximately 10 years ago: type I (aperistalsis), type II (pan-pressurization), and type III (spastic). Since the widespread use of this classification scheme, the evolving prevalence of these subtypes has not been elucidated. We aim to determine the prevalence of each subtype a decade after the adoption of the Chicago Classification. Methods  This is a retrospective cohort analysis of patients diagnosed with achalasia on high-resolution manometry (HRM) at two major academic medical centers between 2015 and 2018. Patients were excluded if they had a diagnosis of another esophageal motility disorder, previously treated achalasia, or foregut surgery. Demographic data, manometric subtype, and esophageal dilatation grade on endoscopy were obtained. Prevalence of achalasia subtypes was compared with a published historical control population (2004–2007). Fischer’s exact and t tests were used for analysis. Results  Of 147 patients in the contemporary cohort and 99 in the historical control cohort, the prevalence of type I achalasia was 8% versus 21%, type II 63% versus 50%, and type III 29% versus 29%, respectively (p = 0.01). The mean age in our population was 58 years compared to 57 years in the historical control, and the proportion of men 48% versus 47%, respectively (p = 0.78). Mean endoscopic dilatation grade in the contemporary cohort was 1.5 for type I patients, 0.9 for type II, and 0.4 for type III, compared with 1.5, 0.6, and 0.4, respectively. Overall mean dilatation grade was 0.8 in our cohort versus 0.7 in the historical control (p = 0.58). Conclusion  The prevalence of type II achalasia was significantly greater and prevalence of type I significantly less in our patient population compared to our predefined historical control. Other characteristics such as age and sex did not appear to contribute to these differences. Histopathological evidence has suggested that type II achalasia may be an earlier form of type I; thus, the increased prevalence of type II achalasia may be related to earlier detection of the disease. The adoption of HRM, widespread use of the Chicago Classification, and increased disease awareness in the past decade may be contributing to these changes in epidemiology. Keywords  Achalasia · High-resolution esophageal manometry · Dysphagia

Introduction

* Daniela Jodorkovsky [email protected] 1



Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, NY, USA



Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

2

Achalasia is a rare esophageal motility di