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Diagnostic delay in achalasia.

Andrea Pasta1, Francesco Calabrese1, Andrea Ghezzi1

  • 1Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|May 18, 2024
PubMed
Summary

Achalasia diagnosis is frequently delayed, with most patients experiencing a late diagnosis. Factors like weight loss and socio-economic status significantly impact diagnostic timeliness, highlighting the need for increased awareness.

Keywords:
Esophageal motor disorderSocioeconomic factorsTailored diagnosis

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Area of Science:

  • Gastroenterology and Esophageal Motility Disorders
  • Diagnostic Delay Analysis
  • Socio-economic Determinants in Healthcare

Background:

  • Achalasia is a rare esophageal motility disorder causing dysphagia, regurgitation, chest pain, and weight loss.
  • Timely diagnosis of achalasia is critical for effective patient management and treatment.
  • Significant diagnostic delays are suspected in achalasia cases.

Purpose of the Study:

  • To evaluate the duration of diagnostic delay in achalasia patients from symptom onset to confirmed diagnosis.
  • To identify key factors associated with delayed achalasia diagnosis.
  • To explore the influence of socio-economic deprivation on diagnostic timelines.

Main Methods:

  • Retrospective, single-center study of 278 achalasia patients diagnosed between January 2013 and September 2023.
  • Data collection included demographics, symptoms, and diagnostic findings (manometry, endoscopy, radiology).
  • Analysis of diagnostic delay, categorizing diagnoses as early (≤12 months) or late (>12 months), and assessing socio-economic deprivation.

Main Results:

  • The median diagnostic delay for achalasia was 24 months, with 76.6% of patients experiencing a late diagnosis.
  • Patients presenting with weight loss were more likely to receive an early diagnosis (63.1% vs. 42.0%).
  • Lower socio-economic deprivation correlated with a significantly shorter diagnostic delay (median 24 months vs. 60 months).

Conclusions:

  • Achalasia diagnosis is frequently delayed, impacting patient outcomes.
  • Weight loss as a symptom and lower socio-economic status are associated with more timely diagnoses.
  • Enhanced disease awareness and recognition of initial symptoms are crucial for facilitating earlier achalasia diagnosis and treatment.