Prevalence of Autoimmune Disease in Patients with Esophageal Achalasia

Jason D Booy, BSc, Julie Takata, George Tomlinson, David R Urbach, MD MSc. Division of General Surgery, University Health Network; and Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Background
Achalasia is a rare disease of the esophagus that has an unknown etiology. Genetic, infectious, and autoimmune mechanisms have each been proposed. Autoimmune diseases often occur in association with one another, either within a single individual or in a family. There have been separate case reports of patients with both achalasia and one or more autoimmune diseases, but no study has yet determined the prevalence of autoimmune diseases in the achalasia population.

Method
We retrospectively reviewed the charts of 193 achalasia patients who received treatment at Toronto’s University Health Network between January 2000 and Feb 2010 to identify other autoimmune diseases and a number of control conditions. We determined the general population prevalence of autoimmune diseases from published epidemiological studies.

Results
The achalasia sample was, on average, 10-15 years older and had slightly more males than the control populations. Compared to the general population, patients with achalasia were 5.4 times more likely to have type I diabetes mellitus (95% confidence interval [CI] 1.5-19), 8.5 times as likely to have hypothyroidism (95% CI 5.0-14), 37 times as likely to have Sjögren’s syndrome (95% CI 1.9-205), 43 times as likely to have systemic lupus erythematosus (95% CI 12-154), and 259 times as likely to have uveitis (95% CI 13-1438). Overall, patients with achalasia were 3.6 times more likely to suffer from any autoimmune condition (95% CI 2.5-5.3).

Conclusions
Our findings are consistent with the impression that achalasia’s etiology has an autoimmune component. Further research is needed to more conclusively define achalasia as an autoimmune disease.