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TOPLINE:

Individuals with achalasia showed a higher risk for mortality than matched reference individuals from the general population, with one additional death per six individuals with achalasia observed over 10 years of follow-up.

METHODOLOGY:

• Researchers conducted a matched cohort study in Sweden including patients diagnosed with achalasia who underwent endoscopic oesophageal examination with biopsy between 1969 and 2017.
• They included 704 adults (median age at diagnosis, 60 years; 56% men) with incident achalasia who were matched with up to five reference individuals (n = 3348) from the general population on the basis of age, sex, birth year, and county, with one or more full siblings without a record of achalasia serving as secondary reference individuals.
• The primary outcome was all-cause mortality, with a median follow-up duration of 9.1 years.
• Incidence rates and absolute rate differences were calculated per 1000 person-years and compared between patients with achalasia and matched reference individuals.

TAKEAWAY:

• During the median follow-up duration of 9.1 years, the incidence rates of mortality events were 69.4 per 1000 person-years among patients with achalasia and 51.9 per 1000 person-years among matched reference individuals; this equated to one additional death for every six patients with achalasia observed over a 10-year period.
• Patients with achalasia had a 42% higher risk for mortality than matched reference individuals (adjusted hazard ratio [aHR], 1.42; 95% CI, 1.21-1.65).
• Moreover, patients with achalasia had an increased risk for mortality due to any cancer (aHR, 1.65; 95% CI, 1.21-2.23), particularly for oesophageal cancer (aHR, 23.19; 95% CI, 3.27-164.55); respiratory diseases (aHR, 2.22; 95% CI, 1.28-3.87); and other causes (aHR, 1.47; 95% CI, 1.12-1.93).
• Compared with full siblings without achalasia (n = 528), patients with achalasia (n = 325) showed an increased risk for all-cause mortality (aHR, 1.78; 95% CI, 1.13-2.81).

IN PRACTICE:

"The elevated mortality risk indicates a need for long-term follow-up of individuals with achalasia, including vigilance for oesophageal cancer and disease-associated complications," the authors wrote.

SOURCE:

This study, led by Anders Forss, MD, PhD, Karolinska Institutet, Stockholm, Sweden, was published online on April 10, 2025, in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

The study lacked data on symptom scores and lifestyle factors such as alcohol use, smoking, diet, or physical activity. Additionally, mortality rates by oesophageal cancer types, diagnostic delays, disease severity, and treatment history could not be assessed.

DISCLOSURES:

This study was supported by research grants from the Bengt Ihre Foundation, Bengt Ihre Research Fellowship, the Swedish Society of Medicine, and the Erling-Persson Foundation. Some authors reported being advisory board members and receiving financial support from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.