P3246 - Patients of Achalasia Are at Increased Risk of Various Cancers: A National Database Study

Tuesday, October 24, 2023

10:30 AM – 4:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

PK

Prabhat Kumar, MD (he/him/his)

Cleveland Clinic Foundation
Cleveland, OH

Prabhat Kumar, MD¹, Thabet Qapaja, MD², Muaz Alsabbagh, MD², Vidhi Patel, MBBS¹, Khaled Alsabbagh Alchirazi, MD², Madhusudhan R.. Sanaka, MD¹, Prashanthi N. Thota, MD¹
¹Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic, Cleveland, OH

Introduction: Achalasia is an esophageal motility disorder characterized by abnormal relaxation of the lower esophageal sphincter and aperistalsis. Typical symptoms of achalasia include dysphagia, regurgitation, chest pain, and weight loss. Achalasia patients are known to have an increased risk of developing cancer, most notably esophageal cancer. However, the prevalence of other associated cancers in achalasia patients is not known. Therefore, we aim to study the prevalence of various extra-esophageal cancers using a national database.

Methods: A large multi-center database (Explorys Inc., Cleveland, OH, USA) of aggregated electronic health records of 26 different healthcare systems with a total of 360 hospitals and more than 70 million patients across the United States was utilized for this study. First, a cohort of patients with a SNOMED-CT diagnosis of "Achalasia" was identified between 1999 and 2022. Subsequently, two sub-cohorts of patients were identified: those diagnosed with achalasia and those who were not. Demographics, including age, gender, and race, were collected. We excluded all patients less than 18 years old, pregnant females, and those with a history of esophagectomy and Roux-en-Y surgery. For all analyses, a 2-sided p-value of < 0.05 was considered statistically significant.

Results: Among the 69,502,120 individuals screened in this database, 30,800 were diagnosed with achalasia. The baseline characteristics of patients with achalasia are shown in Table 1. In comparison to those without, patients with achalasia tend to be older (OR 3.40), female (OR 1.06), and of the Caucasian race (OR 2.61). Achalasia patients were more likely to have esophageal cancer (OR 25.78), breast cancer (OR 3.68), lung cancer (OR 4.72), thyroid cancer (OR 4.12), gastric cancer (OR 12.03), hepatocellular carcinoma (4.50) and Colon cancer (4.45).

Discussion: This is one of the largest population-based studies, which entails prevalence data regarding associated cancers in achalasia patients. Extra-esophageal malignancies are common in achalasia patients. Therefore, a particular focus should be made on diagnosing these malignancies in achalasia patients. Future research is needed to determine if there is a causative relationship.

Parameters		Achalasia (%)	No Achalasia (%)	Odds Ratio	95% CI	p-valve
Age (in years)	Age 18-65	12,200 (39.61)	47,728,940 (68.7)	0.30	0.29 to 0.30	< 0.0001
Age (in years)	Age >65	18,130 (58.8)	20,561,080 (29.5)	3.40	3.33 to 3.48	< 0.0001
Gender	Male	13,370 (43.4)	30,943,050 (44.54)	0.95	0.93 to 0.98	= 0.0001
Gender	Female	17,320 (56.2)	38,041,540 (54.75)	1.06	1.04 to 1.08	< 0.0001
Race	White	23,190 (75.3)	37,372,370 (53.7)	2.62	2.55 to 2.69	< 0.0001
	African American	3,570 (11.6)	7,024,100 (10.11)	1.16	1.12 to 1.21	< 0.0001
	Asian	400 (1.2)	1,125,480 (1.62)	0.80	0.72 to 0.88	< 0.0001
	Hispanic	180 (0.6)	897,860 (1.29)	0.45	0.39 to 0.52	< 0.0001
Malignancies	Esophageal cancer	420 (1.36)	37,210 (0.05)	25.78	23.42 to 28.42	< 0.0001
	Breast cancer	1,130 (3.66)	711,650 (1.02)	3.68	3.47 to 3.90	< 0.0001
	Lung cancer	650 (2.11)	315,620 (0.45)	4.72	4.37 to 5.10	< 0.0001
	Thyroid cancer	180 (0.58)	98,980 (0.14)	4.12	3.56 to 4.77	< 0.0001
	Gastric cancer	220 (0.71)	34,200 (0.04)	14.61	12.79 to 16.68	< 0.0001
	Hepatocellular Carcinoma	120 (0.38)	60,300 (0.08)	4.50	3.76 to 5.39	< 0.0001
	Cholangiocarcinoma	50 (0.16)	90 (0.00012)	1255.13	888.11 to 1773.81	< 0.0001
	Colon Cancer	470 (1.52)	241,280 (0.34)	4.45	4.06 to 4.87	< 0.0001

Disclosures:

Prabhat Kumar indicated no relevant financial relationships.

Thabet Qapaja indicated no relevant financial relationships.

Muaz Alsabbagh indicated no relevant financial relationships.

Vidhi Patel indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Prabhat Kumar, MD¹, Thabet Qapaja, MD², Muaz Alsabbagh, MD², Vidhi Patel, MBBS¹, Khaled Alsabbagh Alchirazi, MD², Madhusudhan R.. Sanaka, MD¹, Prashanthi N. Thota, MD¹. P3246 - Patients of Achalasia Are at Increased Risk of Various Cancers: A National Database Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.