A40 INCIDENCE, CLINICAL FEATURES, AND INVESTIGATION OF ACHALASIA IN NEWFOUNDLAND AND LABRADOR

• Published in: Journal of the Canadian Association of Gastroenterology
• Main Authors: Woodman, K, Fardy, J
• Format: Text
• Language: English
• Published: Oxford University Press 2018
• Subjects: Paper Sessions; Newfoundland
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508432/; https://doi.org/10.1093/jcag/gwy009.040

BACKGROUND: Achalasia is a rare esophageal motility disorder of unknown etiology. Patients commonly present with dysphagia, regurgitation and weight loss. Previous epidemiologic studies have suggested an equal male to female ratio and adult onset. Incidence rates range between 0.29 – 1.63/ 100,000 per year. Endoscopic and esophagram findings are often abnormal, however, manometry is required to diagnose achalasia. AIMS: This 11-year retrospective study outlines incidence, clinical features, and describes diagnostic findings in incident cases of achalasia in Newfoundland and Labrador. METHODS: Patient charts with ICD codes indicating a diagnosis of achalasia between 2005 and 2015 were retrieved from medical records. Charts with a diagnosis of achalasia by manometry prior to 2005 were not reviewed. Patients diagnosed with achalasia based on endoscopy or imaging prior to 2005 were included if their initial diagnostic manometry occurred between 2005 and 2015. The date of diagnosis was recorded as the date of official diagnostic manometry. Epidemiologic data, manometry, endoscopy and esophagram findings were compiled by chart review. RESULTS: 73 cases of achalasia were diagnosed with manometry between 2005 and 2015 in Newfoundland and Labrador. The average age at diagnosis was 52. Males represented 60% of cases. The midpoint incidence of achalasia was 1.42/100,000. Dysphagia occurred in 97% of patients, regurgitation in 73%, weight loss in 71%, chest pain in 22%, and aspiration in 11%. Upper endoscopy was abnormal in 81% of patients. The most common endoscopic finding was narrowing of the gastroesophageal junction followed by dilatation of the esophageal body. Abnormal barium esophagram occurred in 74.0%. An abnormal GEJ was the most common finding on barium esophagram, seen in 64%, followed by esophageal dilatation in 41%. Abnormal manometry was a key feature in all patients. CONCLUSIONS: The incidence of achalasia in Newfoundland is similar to the incidence reported by a similar study in Alberta, although higher ...