Question for Notan, for everyone...

[Guest guest]

Dear Fellow Achalasians, and our Bibliographer!, Notan,

 

        Is there an article discussing how many of us who have serious

throat erosion that end up with Barrett's, and/or esophageal cancers?

And, for that matter, how many Achalasians, percentage-wise, need

-ectomies?

 

        Thanks!

 

Deborah, still out at the beach

 

      

[Guest guest]

Bumping this up. I really worry about throat erosion. I can't imagine

having my food being caught in my throat for hours doesn't cause some

type of erosion. I'm being scoped next month and will definately ask

what it looks like in there. But I'm not educated enough to answer

your question sooooo BUMP! Hope you get a response

, FL

Visit my blog: www.achalasia.today.com

>

> Dear Fellow Achalasians, and our Bibliographer!, Notan,

>  

>         Is there an article discussing how many of us who have serious

> throat erosion that end up with Barrett's, and/or esophageal cancers?

> And, for that matter, how many Achalasians, percentage-wise, need

> -ectomies?

>  

>         Thanks!

>  

> Deborah, still out at the beach

>  

>       

>

>

[Guest guest]

Bumping this up. I really worry about throat erosion. I can't imagine

having my food being caught in my throat for hours doesn't cause some

type of erosion. I'm being scoped next month and will definately ask

what it looks like in there. But I'm not educated enough to answer

your question sooooo BUMP! Hope you get a response

, FL

Visit my blog: www.achalasia.today.com

>

> Dear Fellow Achalasians, and our Bibliographer!, Notan,

>  

>         Is there an article discussing how many of us who have serious

> throat erosion that end up with Barrett's, and/or esophageal cancers?

> And, for that matter, how many Achalasians, percentage-wise, need

> -ectomies?

>  

>         Thanks!

>  

> Deborah, still out at the beach

>  

>       

>

>

[Guest guest]

Deborah wrote:

> Is there an article discussing how many of us who have serious

> throat erosion that end up with Barrett's, and/or esophageal cancers?

> And, for that matter, how many Achalasians, percentage-wise, need

> -ectomies?

>

I don't know of any numbers I would consider solid, but below are some

studies and articles that give some numbers from which you can get a

feel for achalasia progressing to Barrett's and cancer. The numbers

don't do a good job of taking into account how bad reflux or the damage

from it was before Barrett's or cancer but a connections to reflux and

megaesophagus have been noticed. If the studies below are good

indicators, by far most of us will not develop cancer. It stands to

reason though that reflux and esophagitis would increase the risk though.

Long-term outcome and risk of oesophageal cancer after surgery for

achalasia. 2008

http://www.ncbi.nlm.nih.gov/pubmed/18991316

" Among 226 patients who could be traced, 182 of 184 survivors were

contacted and the cause of death established for 41 of 42 patients. At a

median follow-up of 18.3 years, almost 90 per cent of patients were

satisfied with the treatment. Four had developed squamous cell

oesophageal carcinoma 2, 8, 13 and 18 years after surgery, one of whom

was still alive. "

Long-term results after Heller-Dor operation for oesophageal achalasia. 2006

http://www.ncbi.nlm.nih.gov/pubmed/16675239

" One hundred and seventy-four patients (80 men, median age 57 years,

range 7-83) consecutively submitted to first instance transabdominal

Heller-Dor in the period 1978-2002 were considered. ... Seven out of 173

patients (4%), 6 of whom were pre-operatively classified as sigmoid

achalasia, subsequently underwent oesophagectomy, 3 for epidermoid

cancer, 1 for Barrett's adenocarcinoma, 2 for stasis oesophagitis and

recurrent sepsis, 1 for severe dysphagia. Fifteen patients (8.7%) had an

insufficient result due to reflux oesophagitis which appeared in 2 (one

erosion) after 184 and 252 months. All 22 patients, whether surgically

or medically retreated, achieved satisfactory control of dysphagia and

reflux symptoms. "

Transthoracic Heller myotomy for esophageal achalasia: analysis of

long-term results. 2006

http://www.ncbi.nlm.nih.gov/pubmed/16731127

" From 1962 to 1999, 64 patients underwent transthoracic esophagomyotomy.

Five patients had repeat myotomy. ... Follow-up was complete in 86% (56

of 65); mean follow-up was 154 months. Thirty-one patients (48%) were

followed for more than 10 years. Short-term results were good to

excellent in 91% (51 of 56) and long-term in 63% (33 of 52; p < 0.0005).

Late peptic stricture occurred in 4 patients (myotomy only, 2 of 38

[5%]; myotomy plus fundoplication, 2 of 14 [14%]). Fewer patients had

reflux symptoms after fundoplication (myotomy only, 16 of 38 [42%];

myotomy plus fundoplication, 4 of 14 [29%]), whereas late dysphagia was

not reduced (myotomy only, 13 of 38 [34%]; myotomy plus fundoplication,

5 of 14 [36%]). Two patients after myotomy plus fundoplication and 1

after myotomy only had esophagectomy.

The risk of esophageal cancer in patients with achalasia. A

population-based study. 1995

http://www.ncbi.nlm.nih.gov/pubmed/7563560

" A total of 1062 patients with achalasia accumulated 9864 years of

follow-up. The mean age at entry was 57.2 years, and the mean age at

cancer diagnosis was 71.0 years. Esophageal cancer occurred in 24

patients. The risk of esophageal cancer in the first year after

achalasia diagnosis was extremely high (SIR, 126.3; 95% confidence

interval [CI], 63.0 to 226.1) as a consequence of prevalent cancers

leading to distal esophageal obstruction simulating achalasia. "

(First year cancers were often not in primary achalasia, the achalasia

was secondary to existing undiagnosed cancer.)

Barrett's esophagus and achalasia. 2002

http://www.ncbi.nlm.nih.gov/pubmed/11907357

(I have some doubts about this report but it is included anyway.)

" 30 cases of Barrett's esophagus in patients with achalasia have been

reported in the literature. In 73% (22 of 30) of the cases, Barrett's

esophagus was detected after esophagomyotomy. In 20% (6 of 30) of the

cases of achalasia and Barrett's esophagus, adenocarcinoma developed.

The current two cases are unusual because Barrett's esophagus in

achalasia generally develops from gastroesophageal reflux after

esophagomyotomy. No other patients have been reported to develop

Barrett's esophagus after pneumatic dilation alone. "

Achalasia complicated by oesophageal squamous cell carcinoma: a

prospective study in 195 patients. 1992

http://www.ncbi.nlm.nih.gov/pubmed/1541408

(Compare this to the last sentence above. Did the subject of this study

just skip Barrett's or was Barrett's, or this study, missed?)

" 195 consecutive patients with achalasia (90 men and 105 women, mean age

52 years), who were treated by pneumatic dilatation in our institution

between 1973 and 1988 were prospectively studied. None of the patients

had undergone cardiomyotomy. Follow up totalled 874 person years after

pneumatic dilatation. In this period three patients developed an

oesophageal squamous cell carcinoma. The mean age at diagnosis of the

oesophageal carcinoma was 68 years (37, 77, and 89 years). The mean

period between the onset of dysphagia and the diagnosis of the tumour

was 17 years (19, 28, and 5 years); the mean interval between the

diagnosis of achalasia and carcinoma was 5.7 years (5, 8, and 4 years). "

Barrett's esophagus in a patient with achalasia.1985

http://www.ncbi.nlm.nih.gov/pubmed/3993633

" We present the case of a patient with Barrett's esophagus and achalasia

without any previous surgical intervention. "

Barrett's esophagus after cardiomyotomy for esophageal achalasia. 1994

http://www.ncbi.nlm.nih.gov/pubmed/8304296

" After follow-up averaging 13 yr, 46 patients were reexamined with

endoscopy, biopsy, and manometry. Barrett's metaplasia of the distal

esophagus was found in four patients 6, 13, 20, and 23 yr after the

myotomy. These four also underwent ambulatory 24-h pH monitoring. They

had the lowest distal esophageal sphincter pressures (1-5 mm Hg), and

all four had symptoms of gastroesophageal reflux and pathologic pH

values (< 4 in the distal esophagus for 32-62% of the total recording

time). "

Barrett's esophagus complicating achalasia after esophagomyotomy.

A clinical, radiologic, and pathologic study of 70 patients with

achalasia and related motor disorders. 1987

http://www.ncbi.nlm.nih.gov/pubmed/3571900

" Of 70 patients with achalasia and related motor disorders, 3 developed

Barrett's esophagus 5, 8, and 15 years after esophagomyotomy. One of the

three had dysplastic changes in the Barrett's mucosa. "

Achalasia and squamous cell carcinoma of the esophagus: analysis of 241

patients. 1995

http://www.ncbi.nlm.nih.gov/pubmed/7771859

" A personal experience with 241 achalasia patients treated during the

past quarter of a century disclosed that 9 had carcinoma, for a

prevalence of 3.7%. Carcinoma developed in 3 of these 9 while they were

under our observation. "

Esophageal carcinoma and achalasia: prevalence, incidence and results of

treatment. 1991

http://www.ncbi.nlm.nih.gov/pubmed/1778581

" Between 1980 and 1988, we treated 1,521 patients with squamous cell

carcinoma of the esophagus and 336 patients with adenocarcinoma of the

gastric cardia. Between 1967 and 1988, 244 patients with esophageal

achalasia were also observed. ... The mean follow-up of the 244 patients

with primary esophageal achalasia was 44.6 months (range 1-108), and

only 1 patient developed an esophageal cancer, ... "

notan

[Guest guest]

Dear Notan,

 

        Your bibliography and your attentions to posting it are fantastic and

I thank you very, very much for all of this information.  I am so impressed

with the breadth and depth of your information and I am truly grateful for

this and your other numerous, and extremely helpful contributions.

 

         Thank you,  Deborah