Epidemiological analysis of achalasia in Japan using a large-scale claims database

  • Hiroki SatoEmail author
  • Hiroshi Yokomichi
  • Kazuya Takahashi
  • Kentaro Tominaga
  • Takeshi Mizusawa
  • Naruhiro Kimura
  • Yuzo Kawata
  • Shuji Terai
Original Article—Alimentary Tract



Achalasia is a well-known esophageal motility disorder, but epidemiological studies in Japan are lacking. We investigated the incidence and period prevalence of achalasia in Japan, including the rate of coexistence of esophageal carcinoma, and evaluated treatment trends.


To estimate the nationwide number of patients with achalasia, a large-scale insurance claims database from 2005 to 2017 were used for our analyses. Patients with achalasia and coexistence of esophageal carcinoma were identified based on the diagnosis code registered. Interventional treatment was also evaluated.


Of the total 5,493,650 populations, 385 were diagnosed with primary achalasia. The incidence was calculated as 0.81–1.37 per 100,000 person-years (male-to-female ratio was almost 1; mean age at diagnosis was 43.3 ± 14.4 years). The period prevalence was 7.0 per 100,000 persons. There were statistically significant trends of increase in the incidence and period prevalence over age groups (all p values < 0.0001). Four men with achalasia developed esophageal carcinoma, and the incidence of esophageal carcinoma with achalasia was estimated as 0.25 per 100 person-years. With regard to intervention, esophageal dilation was performed as a first treatment in 64.7% of patients, with repeat intervention required in 56.9% of these. The proportion of patients treated using peroral endoscopic myotomy (POEM) increased annually to 41.1% in 2017.


In Japan, the incidence and period prevalence of achalasia is comparable to that in other countries. The absolute risk of esophageal carcinoma is rather low. Esophageal dilation has been the mainstay of achalasia treatment, and the role of POEM has increased annually.


Achalasia Japanese Peroral endoscopic myotomy Esophageal carcinoma Epidemiology 



This work was supported by JSPS KAKENHI Grant Number 18K15805.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

535_2018_1544_MOESM1_ESM.jpg (125 kb)
Supplementary material 1 (JPEG 125 kb)


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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyNiigata University Medical and Dental HospitalNiigataJapan
  2. 2.Department of Health SciencesUniversity of YamanashiChuo City, YamanashiJapan

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