Changing Trends in Age, Gender, Racial Distribution and Inpatient Burden of Achalasia

BACKGROUND Achalasia is an idiopathic esophageal motility disorder characterized by dysphagia, regurgitation, chest discomfort and weight loss. The aim of this study was to evaluate the temporal trends in demographic variables, interventions, and inpatient burden in achalasia-related hospitalizations. METHODS We evaluated the National Inpatient Sample Database (NIS) for all patients in whom achalasia (ICD-9 code: 530.0) was the principal discharge diagnosis from 1997 to 2013. Data regarding the patient demographics, number of hospitalizations, length of stay, associated hospital costs and temporal trends over the study period were obtained. RESULTS In 1997, there were 2,493 admissions with a principal discharge diagnosis of achalasia as compared to 5,195 in 2013 with an average increase of 4% per year (P < 0.001). In 1997, the proportion of patients under 65 years of age was 53.8% versus 60.1% in 2013. Increasing prevalence in African Americans was noted (11.1% to 17.1%). Inflation-adjusted hospital charges related to achalasia showed a mean increase of $2,521 per year (P < 0.001). There was an increase in Heller myotomy procedures over the study period (P < 0.001). CONCLUSIONS The number of hospitalizations for achalasia and associated costs has significantly increased significantly over the last 16 years in the United States with disproportionate increase in patients under 65 years of age and racial minorities. Further research on cost-effective evaluation and management of achalasia is required.