Achalasia is Strongly Associated With Eosinophilic Esophagitis and Other Allergic Disorders.

Autor:	Reddy CA; Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas; Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas., Allen-Brady K; Department of Medicine, University of Utah, Salt Lake City, Utah., Uchida AM; Department of Medicine, University of Utah, Salt Lake City, Utah., Peterson KA; Department of Medicine, University of Utah, Salt Lake City, Utah., Hoffman AM; Department of Medicine, University of Utah, Salt Lake City, Utah., Souza RF; Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas; Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas., Spechler SJ; Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas; Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas. Electronic address: stuart.spechler@BSWHealth.org.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2024 Jan; Vol. 22 (1), pp. 34-41.e2. Date of Electronic Publication: 2023 Jun 28.
DOI:	10.1016/j.cgh.2023.06.013
Abstrakt:	Background & Aims: Achalasia has been assumed to be an autoimmune disease targeting esophageal myenteric neurons. Recently, we proposed an alternative hypothesis that achalasia sometimes might be allergy-driven, caused by a form of eosinophilic esophagitis (EoE) in which activated eosinophils and/or mast cells infiltrating esophageal muscle release products that disrupt motility and damage myenteric neurons. To seek epidemiologic support for this hypothesis, we identified patients with achalasia in the Utah Population Database, and explored their frequency of having EoE and other allergic disorders. Methods: We used International Classification of Diseases codes to identify patients with achalasia and allergic disorders including EoE, asthma, atopic dermatitis, contact dermatitis, allergic rhinitis, allergic conjunctivitis, hives/urticaria, and anaphylaxis. We calculated relative risk (RR) for each allergic disorder by comparing the number observed in patients with achalasia with the expected number in individuals matched for birthyear and sex, and we performed subanalyses for patients age ≤40 versus age >40 years. Results: Among 844 patients with achalasia identified (55% female; median age at diagnosis, 58 years), 402 (47.6%) had ≥1 allergic disorder. Fifty-five patients with achalasia (6.5%) had EoE (1.67 EoE cases expected), for a RR of 32.9 (95% confidence interval, 24.8-42.8; P < .001). In 208 patients with achalasia age ≤40 years, the RR for EoE was 69.6 (95% confidence interval, 46.6-100.0; P < .001). RR also was increased significantly for all other allergic disorders evaluated (all greater than 3-fold higher than population rates). Conclusions: Achalasia is strongly associated with EoE and other allergic disorders. These data support the hypothesis that achalasia sometimes might have an allergic etiology. (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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