Article Text

Download PDFPDF
Original article
Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data
  1. Philip R Harvey1,2,
  2. Tom Thomas2,
  3. Joht S Chandan2,
  4. Jemma Mytton3,
  5. Ben Coupland3,
  6. Neeraj Bhala2,
  7. Felicity Evison3,
  8. Prashant Patel3,
  9. Krishnarajah Nirantharakumar2,
  10. Nigel J Trudgill1
  1. 1 Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  2. 2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  3. 3 Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Krishnarajah Nirantharakumar, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; K.Nirantharan{at}


Background Achalasia is an uncommon condition characterised by failed lower oesophageal sphincter relaxation. Data regarding its incidence, prevalence, disease associations and long-term outcomes are very limited.

Methods Hospital Episode Statistics (HES) include demographic and diagnostic data for all English hospital attendances. The Health Improvement Network (THIN) includes the primary care records of 4.5 million UK subjects, representative of national demographics. Both were searched for incident cases between 2006 and 2016 and THIN for prevalent cases. Subjects with achalasia in THIN were compared with age, sex, deprivation tand smoking status matched controls for important comorbidities and mortality.

Results There were 10 509 and 711 new achalasia diagnoses identified in HES and THIN, respectively. The mean incidence per 100 000 people in HES was 1.99 (95% CI 1.87 to 2.11) and 1.53 (1.42 to 1.64) per 100 000 person-years in THIN. The prevalence in THIN was 27.1 (25.4 to 28.9) per 100 000 population. Incidence rate ratios (IRRs) were significantly higher in subjects with achalasia (n=2369) compared with controls (n=3865) for: oesophageal cancer (IRR 5.22 (95% CI: 1.88 to 14.45), p<0.001), aspiration pneumonia (13.38 (1.66 to 107.79), p=0.015), lower respiratory tract infection (1.33 (1.05 to 1.70), p=0.02) and mortality (1.33 (1.17 to 1.51), p<0.001). The median time from achalasia diagnosis to oesophageal cancer diagnosis was 15.5 (IQR 20.4) years.

Conclusion The incidence of achalasia is 1.99 per 100 000 population in secondary care data and 1.53 per 100 000 person-years in primary care data. Subjects with achalasia have an increased incidence of oesophageal cancer, aspiration pneumonia, lower respiratory tract infections and higher mortality. Clinicians treating patients with achalasia should be made aware of these associated morbidities and its increased mortality.

  • achalasia
  • mortality
  • oesophageal cancer
  • epidemiology
  • lower respiratory tract infection
  • aspiration pneumonia

Statistics from


  • KN and NJT contributed equally.

  • Contributors PRH, TT, NJT and KN conceived of the study design. All authors participated in data collection and analysis. All authors contributed to the drafting of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The THIN data collection scheme received multicentre research ethics committee (MREC) approval in 2003 with scientific committee approval of this particular study in March 2017 (SRC17THIN133) from ‘IMSHealth’ (data provider).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.