Clinical correlation and disease phenotype in patients with esophageal achalasia and comorbid autoimmune diseases

BACKGROUND

There is evidence that idiopathic achalasia has an autoimmune component and a significant association with several autoimmune comorbidities has been described. However, data regarding the prevalence of autoimmune diseases in achalasia are not well established, and few studies have explored this association.

OBJECTIVE

Our primary aim was to prospectively investigate the type and frequency of autoimmune comorbidities in a large cohort of consecutive achalasia patients. Our secondary aim was to investigate the effects of autoimmune comorbidities on achalasia phenotype (clinical features and manometric pattern).

METHODS

The study population consisted of 375 consecutive patients (215 females-median age 55 ± 17 years), referred at our tertiary referral center from January 2008 to January 2018, with clinical and instrumental (EGDS, barium esophagogram, and manometry) diagnosis of idiopathic achalasia. Gender- and age-matched subjects undergoing manometry and pH-impedance monitoring for typical gastroesophageal reflux (GERD) complaints served as controls. In all patients a detailed history taking was carried out, recording the presence and type of autoimmune comorbidities.

RESULTS

The overall prevalence of autoimmune comorbidities was two times higher in achalasia than in control patients (12.3 vs. 5%, respectively). The presence of comorbidities did not significantly affect disease's phenotype, as the age of disease onset was similar in achalasia patients with and without comorbidities (50.13 ± 14.47 and 48.3 ± 18.71, respectively, P = NS).

CONCLUSIONS

Although larger epidemiologic studies are needed to confirm our data, our findings likely suggest that achalasia has a complex multifactorial pathophysiology with an autoimmune component.

Retrospective study on adjuvant chemotherapy after surgical resection of colorectal cancer metastatic to the liver

As a means of defining the role of chemotherapy after radical resection of colorectal liver metastases, a follow-up study of consecutive cases referred to three different surgical clinics, between June 1977 and December 1990 was performed. Data were collected from medical records and recorded on standardized forms. Analysis focused on the impact of treatment on survival of the study population by Cox multivariate analysis. One hundred and twenty-four primary colon cancer cases were reviewed and 102 were fully evaluable. Forty of the 102 were given 5FU based chemotherapy. According to multivariate survival analysis, time to hepatic metastasis (synchronous vs metachronous, RR = 0.41, 95%, C.I. = 0.21-0.78; P = 0.007) and sex (female vs male, RR = 0.48, 95% C.I. = 0.25-0.93; P = 0.029) were significantly associated with better survival. The relative risk of dying associated with treatment was 0.53 (95% C.I. = 0.27-1.05; P = 0.0675). This study suggests that chemotherapy may have an impact on survival, although the size of the effect is not precise. Multicentric randomized clinical trials are required to define the risk/benefit profile of adjuvant chemotherapy.