Esophageal cancer risk increased in achalasia patients

MedWire News: People with achalasia, a rare esophageal motility disorder, are at increased risk for esophageal cancer compared with the general population, study findings show.

Ivonne Leeuwenburgh (Erasmus University Medical Center, Rotterdam, The Netherlands) and colleagues recruited 448 patients diagnosed with primary achalasia to take part in a study to assess risks for esophageal cancer and the benefits of endoscopic surveillance over a period of 9.6 years. The patients were aged 51 years on average at diagnosis.

Over the follow-up period, 15 achalasia patients developed esophageal cancer, with an annual incidence rate of 0.34%. This rate is slightly lower than that reported for individuals with Barrett's esophagus at 0.50-1.00%.

Patients had been offered endoscopic surveillance at 1, 2, 4, and 7 years after diagnosis. Ten of the 15 patients were diagnosed with esophageal cancer following endoscopy, while five patients had stopped surveillance.

Ten of the patients who developed cancer were diagnosed with advanced disease and so received palliative care only. The other five patients underwent esophageal resection surgery, two of whom had a disease-free survival period of 8 years or more and three of whom died within 6 years, two from recurrent cancer.

"The prognosis of patients with achalasia and esophageal carcinoma remains poor, even when they were under regular endoscopic surveillance," write the authors in the American Journal of Gastroenterology.

"To improve this prognosis, we should define high-risk achalasia patients and keep them under more frequent, probably annual, endoscopic surveillance," they conclude.

"More studies are needed to establish the optimal screening interval and technique."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010