Incidence and Prevalence of Achalasia in Central Chicago, 2004–2014, Since the Widespread Use of High-Resolution Manometry

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d14471890e161">Background &amp; Aims</h5> <p id="P1">Reported global incidence and prevalence values for achalasia vary widely, from 0.03 to 1.63/100,000 persons per year and from 1.8 to 12.6/100,000 persons per year, respectively. This study aimed to reconcile these low values with findings from a major referral center, in central Chicago (which has been utilizing high-resolution manometry since 2004 and for all clinical studies since 2005), and have determined the incidence and prevalence of achalasia to be much greater. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d14471890e166">Methods</h5> <p id="P2">We collected data from the Northwestern Medicine Enterprise Data Warehouse (NMEDW) database (tertiary care setting) of adults residing in Chicago with an encounter diagnosis of achalasia from 2004 through 2014. Patient files were reviewed to confirm diagnosis and residential address. US Census Bureau population data were used as the population denominator. We assumed that we encountered every incident case in the city to calculate incidence and prevalence estimates. Data were analyzed for the city at large and for the 13 zip codes surrounding the Northwestern Memorial Hospital (NMH), the NMH neighborhood. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d14471890e171">Results</h5> <p id="P3">We identified 379 cases (50.9% female) that met the full inclusion criteria; of these, 246 were incident cases. Among these, 132 patients resided in the NMH neighborhood, 89 of which were incident cases. Estimated yearly incidences were stable over the study period, ranging from 0.77 to 1.35/100,000 citywide (average 1.07/100,000) and from 1.41 to 4.60/100,000 in the NMH neighborhood (average 2.92/100,000). The corresponding prevalence values increased progressively, from 4.68 to 14.42/100,000 citywide and from 15.64 to 32.58/100,000 in the NMH neighborhood. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d14471890e176">Conclusion</h5> <p id="P4">The incidence and prevalence of achalasia in central Chicago diagnosed using state-of-the-art technology and diagnostic criteria are at least 2–3-fold greater than previous estimates. Additional studies are needed to determine the generalizability of these data to other regions. </p> </div>