Issue: December 2022
Fact checked byHeather Biele

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October 31, 2022
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Achalasia associated with fivefold higher risk for esophageal cancer

Issue: December 2022
Fact checked byHeather Biele
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CHARLOTTE, N.C. — Achalasia was associated with an increased risk for esophageal cancer among a cohort of veterans, suggesting the need for increased endoscopic surveillance, according to a presenter at the ACG Annual Scientific Meeting.

Perspective from Yi Qin, MD

“Achalasia is a postulated risk factor for esophageal cancer. The suggested cause of pathophysiology relates to stasis esophagitis,” Eric E. Low, MD, MPH, an internal medicine resident at the University of California, San Diego, said. “Esophageal cancer-associated risk and outcomes in individuals with achalasia have been understudied, and as such, there are no guidelines for surveillance endoscopy for those with achalasia.”

Increased risk for esophageal cancer among patients who had: Achalasia; HR = 5.4 Candida esophagitis; HR = 18.3

Seeking to evaluate the risk for esophageal cancer among patients with achalasia vs. those without achalasia, Low and colleagues matched 1,866 veterans with achalasia to 7,464 veterans without achalasia, all who received care through the Veterans Health Administration between 1999 and 2020. The median age of participants was 55 years and 92% were men.

Over the study period, researchers reported 17 cases of esophageal cancer among veterans with achalasia and 15 cases of esophageal cancer among veterans without achalasia. The median time from achalasia diagnosis to cancer development was 3 years, and those with achalasia had more than fivefold increased risk for esophageal cancer (HR = 5.4; 95% CI, 2.8-10.5) compared to those without.

Researchers also reported a higher cumulative incidence of esophageal cancer among those with vs. without achalasia at 5-, 10- and 15-years follow-up.

Post-hoc analysis further revealed Candida esophagitis preceded cancer diagnosis (median time, 1.3 years) in 12.5% of veterans, and patients with vs. without Candida esophagitis had an 18.3-fold higher risk for esophageal cancer (95% CI, 6.2-53.7).

“Using a nationwide cohort of individuals with achalasia, we found a 5.4-fold increased risk of esophageal cancer among individuals with vs. without achalasia,” Low concluded. “The implications for this are that individuals with achalasia may benefit from a high index of suspicion and endoscopic surveillance for esophageal cancer.”

“We also found that Candida esophagitis exposure was associated with esophageal cancer risk,” he continued. “More research is needed to understand whether Candida contributes to esophageal cancer pathogenesis or is merely a manifestation of more severe statis that may be driving esophageal cancer risk.”