Epidemiological analysis of achalasia in Japan using a large-scale claims database

Background Achalasia is a well-known esophageal motility disorder, but epidemiological studies in Japan are lacking. We investigated the incidence and period prevalence of achalasia in Japan, including the rate of coexistence of esophageal carcinoma, and evaluated treatment trends. Methods To estima...

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Bibliographic Details
Published in:Journal of gastroenterology 2019-07, Vol.54 (7), p.621-627
Main Authors: Sato, Hiroki, Yokomichi, Hiroshi, Takahashi, Kazuya, Tominaga, Kentaro, Mizusawa, Takeshi, Kimura, Naruhiro, Kawata, Yuzo, Terai, Shuji
Format: Article
Language:English
Subjects:
Abdominal Surgery
Achalasia
Coexistence
Colorectal Surgery
Diagnosis
Epidemiology
Esophageal cancer
Esophageal carcinoma
Esophagus
Gastroenterology
Hepatology
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Original Article—Alimentary Tract
Patients
Prevalence studies (Epidemiology)
Statistical analysis
Surgical Oncology
Trends
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Summary:Background Achalasia is a well-known esophageal motility disorder, but epidemiological studies in Japan are lacking. We investigated the incidence and period prevalence of achalasia in Japan, including the rate of coexistence of esophageal carcinoma, and evaluated treatment trends. Methods To estimate the nationwide number of patients with achalasia, a large-scale insurance claims database from 2005 to 2017 were used for our analyses. Patients with achalasia and coexistence of esophageal carcinoma were identified based on the diagnosis code registered. Interventional treatment was also evaluated. Results Of the total 5,493,650 populations, 385 were diagnosed with primary achalasia. The incidence was calculated as 0.81–1.37 per 100,000 person-years (male-to-female ratio was almost 1; mean age at diagnosis was 43.3 ± 14.4 years). The period prevalence was 7.0 per 100,000 persons. There were statistically significant trends of increase in the incidence and period prevalence over age groups (all p values < 0.0001). Four men with achalasia developed esophageal carcinoma, and the incidence of esophageal carcinoma with achalasia was estimated as 0.25 per 100 person-years. With regard to intervention, esophageal dilation was performed as a first treatment in 64.7% of patients, with repeat intervention required in 56.9% of these. The proportion of patients treated using peroral endoscopic myotomy (POEM) increased annually to 41.1% in 2017. Conclusions In Japan, the incidence and period prevalence of achalasia is comparable to that in other countries. The absolute risk of esophageal carcinoma is rather low. Esophageal dilation has been the mainstay of achalasia treatment, and the role of POEM has increased annually.
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-018-01544-8