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Ethnic Differences in Clinical Presentations and Esophageal High-Resolution Manometry Findings in Patients with Achalasia

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Abstract

Background

Ethnic differences in achalasia presentations have scarcely been described. The association between achalasia and immunologic HLA haplotypes suggests that there may be a genetic predisposition. We aimed to evaluate differences in demographic, clinical, endoscopic, and manometric findings between two distinct ethnic groups with achalasia—Israeli Arabs (IA) and Israeli Jews (IJ).

Methods

A retrospective study was performed at two medical centers. High-resolution manometry (HRM) reports were reviewed for newly-diagnosed achalasia patients. Demographic data, clinical presentations, endoscopy reports, and HRM metrics including the integrated relaxation pressure (IRP) were all reviewed.

Results

Overall, 94 achalasia patients were included (53.2% male; mean age 54.5 ± 18.0). 43 patients were IA (45.7%). Body mass index (BMI) was similar in both groups. Compared to IJ, the IA patients had more esophageal dysphagia (100% vs. 88.2%; P = 0.022), chest pain (46.5% vs. 25.5%; P = 0.033), and a tortuous esophagus on endoscopy (23.3% vs. 3.9%; p = 0.005). IA patients were also diagnosed at a younger age than IJ patients (50.9 ± 17.5 vs. 57.5 ± 18.0; p = 0.039). Furthermore, IRP values were higher among IA patients than IJ patients (32.2 ± 13.8 vs. 23.3 ± 8.4; p < 0.001). A regression model analysis found that ethnicity significantly predicted IRP (β = − 10, p < .001).

Conclusion

Ethnicity appears to affect achalasia clinical presentation and HRM findings. IA achalasia patients are diagnosed at a younger age, present with more severe esophageal symptoms, and have a higher IRP compared to IJ patients. Additional studies of diverse, multiethnic populations, especially with genetic evaluations, are required to further assess the role of ethnicity in achalasia.

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Data Availability

The dataset is available from the authors upon reasonable request.

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

HRM:

High-resolution manometry

SD:

Standard deviation

IRP:

Integrated relaxation pressure

EGJ:

Esophagogastric junction

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Shamir (Assaf Harofeh) Medical Center, The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, 70300, Zerifin, Israel

    Daniel L. Cohen, Anton Bermont & Haim Shirin

  2. Faculty of Medicine, Bar Ilan University, Safed, Israel

    Basem Hijazi & Amir Mari

  3. Gastroenterology and Endoscopy Unit, Nazareth EMMS Hospital, Nazareth, Israel

    Ali Omari, Helal Said Ahmad, Narjes Azzam & Amir Mari

  4. Ha’Emek Medical Center, Gastroenterology Institiute, Afula, Israel

    Fahmi Shibli

  5. Rabin Medical Center, Gastroenterology Institute, Tel Aviv University, Petah Tikva, Israel

    Ram Dickman

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Contributions

AM and DLC are the guarantors and designed the study; BH, AB, HAS, NA and AO participated in the acquisition, analysis, and interpretation of the data. AM, DLC, BH, and RD drafted the initial manuscript; AM, DLC, FS, HS, and RD revised the article critically for important intellectual content. All authors contributed significantly to this manuscript.

Corresponding author

Correspondence to Daniel L. Cohen.

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Conflict of interest

The authors have no financial interests to disclose.

Ethical Approval

Ethics approval was received from the Institutional Review Board at Nazareth Hospital.

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The need for informed consent was waived by the IRB given the study’s retrospective nature and use of anonymous data.

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Cohen, D.L., Hijazi, B., Omari, A. et al. Ethnic Differences in Clinical Presentations and Esophageal High-Resolution Manometry Findings in Patients with Achalasia. Dysphagia 38, 1247–1253 (2023). https://doi.org/10.1007/s00455-022-10549-8

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