Achalasia Tied to EoE, Other Allergic Disorders


The risk for allergic disorders, especially eosinophilic esophagitis (EoE), is significantly higher in people with achalasia, suggesting the need for an EoE evaluation before embarking on invasive achalasia treatment, researchers say.


  • ICD codes were used to identify patients with achalasia and allergic disorders from the Utah Population Database.

  • Among 844 patients with achalasia (mean age at diagnosis, 58 years; 55% women), 402 patients (48%) had one or more allergic disorders.

  • The relative risk (RR) for allergic disorders in patients with achalasia compared with a matched population was calculated, with subanalyses for patients age 40 years and younger and 41 and older.


  • Of patients with achalasia, 55 (6.5%) had EoE (vs 1.67 expected EoE cases), for a relative risk of 32.9 (95% CI, 24.8 – 42.8; P < .001).

  • In 208 patients with achalasia age 40 and younger, the RR for EoE was 69.6 (95% CI, 46.6 – 100.0; P < .001).

  • The RR for other allergic disorders — dermatitis, allergic rhinitis/conjunctivitis, hives/urticaria, and anaphylaxis — was also significantly increased (all greater than threefold above population rates).


“Since there are well documented cases of achalasia-like esophageal motility abnormalities resolving with EoE treatments, it seems prudent to evaluate achalasia patients carefully for EoE and, if found, to treat it before embarking on definitive achalasia therapies,” the researchers write.


The study was led by Chanakyaram A. Reddy, MD, with the Center for Esophageal Diseases at Baylor University Medical Center, Dallas, Texas. It was published online June 28 in Clinical Gastroenterology and Hepatology. The study was supported by the Baylor Scott & White Research Institute.


Diagnoses were based on ICD codes, which can be inaccurate. The study population was primarily of European ancestry; therefore, the results may not apply to all racial or ethnic groups. The study demonstrated strong associations but does not establish cause and effect.


No conflicts of interest were reported.

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