Complications
This results from aspiration of retained material in the oesophagus, with nocturnal aspiration being a particular problem.
In the US, approximately 10% of people with achalasia in hospitals have pulmonary complications.[13]
GORD is the most common cause for post-surgical treatment failure.
In one 10-year follow-up study, 14 of 67 patients (21%) developed severe reflux disease oesophagitis despite a partial anti-reflux procedure.[57] The severity of reflux disease increased with increasing duration of follow-up. In one series, 9 patients (13%) developed Barrett's oesophagus.[57] Rarely, a peptic stricture can result.[74] In one trial, reflux oesophagitis was reported in 7% of patients who underwent pneumatic dilatation for newly diagnosed achalasia.[52] Gastro-oesophageal reflux following pneumatic dilatation is usually mild and responds well to acid suppression.
Since the incidence of GORD is higher after a peroral endoscopic myomectomy (POEM), patients who undergo POEM should be monitored for GORD.[41] Many patients require long-term proton pump inhibitor (PPI) therapy for symptomatic reflux or erosive oesophagitis following POEM.[36][41]
There may be an increased risk of squamous cell oesophageal carcinoma in patients with achalasia.[79] One systematic review and meta-analysis reported an incidence of 312.4 cases per 100,000 patient-years at risk.[80]
One large UK study reported that oesophageal cancer was 5 times more likely in patients with achalasia than in matched controls, presenting on average 15 years after diagnosis.[9]
Squamous cell oesophageal carcinoma is thought to result from chronic injury to the oesophageal mucosa due to retained ingested food and other noxious compounds.[81] The diagnosis is often made late, because patients already have a degree of dysphagia and any obstructing lesion has to be much larger to cause symptoms in a dilated oesophagus.[79][81]
The outcome is therefore poor; however, endoscopic surveillance is not standard practice.[81]
In a survey of physicians who treat achalasia, 82% felt that achalasia incurred an increased lifetime risk of carcinoma and 89% endorsed routine screening every 2-5 years.[82]
Use of this content is subject to our disclaimer