Barrett’s Esophagus and Esophageal Adenocarcinoma Are Common After Treatment for Achalasia

• Published in: Digestive diseases and sciences 2013, Vol.58 (1), p.244-252
• Main Authors: Leeuwenburgh, I., Scholten, P., Caljé, T. J., Vaessen, R. J., Tilanus, H. W., Hansen, B. E., Kuipers, E. J.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - etiology; Adult; Aged; Aged, 80 and over; Analysis; Barium; Barrett Esophagus - etiology; Biochemistry; Development and progression; Drug therapy; Esophageal Achalasia - complications; Esophageal diseases; Esophageal Neoplasms - etiology; Female; Follow-Up Studies; Gastroenterology; Gastrointestinal agents; Health aspects; Hepatology; Hernia; Histamine H2 Antagonists; Humans; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Pneumoviridae; Proton Pump Inhibitors; Transplant Surgery; Treatment Outcome
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-012-2157-9

Background Achalasia is characterized by esophageal aperistalsis and impaired relaxation of the lower esophageal sphincter (LES). This contrasts with an insufficient LES, predisposing to gastro-esophageal reflux and Barrett’s esophagus. The co-incidence of achalasia and BE is rare. Pneumatic dilatation (PD) may lead to gastro-esophageal reflux, Barrett’s esophagus development, and esophageal adenocarcinoma. Aims To determine the incidence of Barrett’s esophagus and esophageal adenocarcinoma in achalasia patients treated with PD. Methods We performed a single-center cohort follow-up study of 331 achalasia patients treated with PD. Mean follow-up was 8.9 years, consisting of regular esophageal manometry, timed barium esophagram, and endoscopy. Results Twenty-eight (8.4 %) patients were diagnosed with Barrett’s esophagus, one at baseline endoscopy. This corresponds with an annual incidence of Barrett’s esophagus of 1.00 % (95 % CI 0.62–1.37). Hiatal herniation was present in 74 patients and 21 developed Barrett’s esophagus compared to seven of 257 patients without a hiatal hernia. Statistical analysis revealed a hazard ratio of 8.04 to develop Barrett’s esophagus if a hiatal hernia was present. Post-treatment LES pressures were lower in patients with Barrett’s esophagus than in those without (13.9 vs. 17.4 mmHg; p  = 0.03). Two (0.6 %) patients developed esophageal adenocarcinoma during follow-up. Conclusions Barrett’s esophagus is incidentally diagnosed in untreated achalasia patients despite high LES pressures, but is more common after successful treatment, especially in the presence of hiatal herniation. Patients treated for achalasia should be considered for GERD treatment and surveillance of development of Barrett’s esophagus, in particular, when they have low LES pressures and a hiatal herniation.