Achalasia natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Ahmed Younes M.B.B.CH [2]

Natural History

• The disease has a slow onset of symptoms, therefore the condition is usually advanced at the time of presentation.
• If left untreated, the disease can progress causing complications such as candida esophagitis, esophageal perforation and aspiration pneumonia. However, achalasia does not alter the lifespan of the patients.

Complications

Achalasia may be complicated by

• Gastroesophageal reflux disease (GERD) or heartburn.
• Achalasia patients have an increased risk of developing Barrett's esophagus or Barrett's mucosa, a premalignant condition which may lead to esophageal cancer over a period of years.
• Aspiration pneumonia: Food and liquid, including saliva, are retained in the esophagus and may be inhaled into the lungs, especially while sleeping in a horizontal position.
• Tearing (perforation) of the esophagus
• The incidence of esophageal cancer is controversial in patients with achalasia. Some Swedish studies report an increased incidence and suggest routine surveillance esophagogastroduodenoscopy (EGD). This has not been shown to be the case in the U.S.A., and current recommendations do not include routine EGD.

Prognosis

• With treatment, the outcome for achalasia is usually good.
• The cure rate ranges from 60 to 90% for surgical interventions.