Nationwide Study Links Achalasia to Elevated Long-Term Mortality Risk
A large, population-based cohort study from Sweden, published in Clinical Gastroenterology and Hepatology, has found that individuals diagnosed with achalasia face a significantly higher risk of all-cause mortality compared with the general population, with the greatest risk increase linked to esophageal cancer and respiratory disease.
The study, which followed 704 adults with incident achalasia between 1969 and 2017, reported a 1.42-fold increased risk of death compared to matched controls (adjusted hazard ratio [aHR] 1.42; 95% CI, 1.21–1.65). During a median follow-up of 9.1 years, the incidence rate of death among those with achalasia was 69.4 per 1,000 person-years, versus 51.9 per 1,000 in the control group.
“This corresponds to approximately one additional death for every six individuals with achalasia followed over 10 years,” the authors stated.
Cause-specific analyses revealed that individuals with achalasia were at significantly increased risk of cancer-related mortality (aHR 1.65; 95% CI, 1.21–2.23), particularly from esophageal cancer (aHR 23.19; 95% CI, 3.27–164.55). Deaths due to respiratory disease were also more common (aHR 2.22; 95% CI, 1.28–3.87).
Cardiovascular disease did not appear to contribute significantly to the elevated mortality (aHR 1.10; 95% CI, 0.84–1.45).
To ensure robustness, the study included a secondary analysis comparing achalasia patients with their full siblings, which yielded consistent results, reinforcing the validity of the findings.
“These data support a clear association between achalasia and long-term mortality, particularly due to malignancy and respiratory causes,” the authors wrote. “The elevated mortality risk indicates a need for long-term follow-up.”
For gastroenterologists, these findings highlight the importance of vigilant surveillance and proactive management in patients with achalasia, even years after diagnosis. Clinicians may need to consider routine assessments for esophageal malignancy and respiratory complications as part of a long-term care strategy.
Reference
Forss A, Hansson MR, Holmberg D, et al. All-cause and cause-specific mortality in achalasia: A nationwide matched cohort study. Clinical Gastroenterology and Hepatology. April 2025. doi:10.1016/j.cgh.2025.02.011
