Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2016; 22(38): 8615-8623
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8615
Incidence, clinical features and para-clinical findings of achalasia in Algeria: Experience of 25 years
Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Hakim Brahimi, Nadia Oumnia
Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Nadia Oumnia, Internal Medicine Department, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria
Hakim Brahimi, Department of Epidemiology, National Public Health Institute, El Biar, University of Algiers 1, Algiers 16000, Algeria
Author contributions: Tebaibia A designed the study; Tebaibia A revised the manuscript for final submission; Tebaibia A, Boudjella MA, Boutarene D and Oumnia N recruited the patients; Tebaibia A, Boudjella MA and Benmediouni F interpreted the data and wrote the manuscript; Tebaibia A, Boudjella MA and Oumnia N performed endoscopy on all patients; Tebaibia A and Boutarene D collected the data; Tebaibia A, Boutarene D and Oumnia N performed the manometry; Brahimi H performed the statistical analysis.
Supported by the Algerian Ministry of Population Health and Hospital Reform and the Ministry of Higher Education and Scientific Research (in part).
Conflict-of-interest statement: None to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amar Tebaibia, MD, PhD, Professor, Department of Internal Medicine, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria. tebaibia@hotmail.com
Telephone: +213-560091065 Fax: +213-23703405
Received: April 25, 2016
Peer-review started: April 26, 2016
First decision: June 20, 2016
Revised: July 6, 2016
Accepted: August 5, 2016
Article in press: August 5, 2016
Published online: October 14, 2016
Processing time: 170 Days and 12 Hours
Abstract
AIM

To investigate the incidence of achalasia in Algeria and to determine its clinical and para-clinical profile. To evaluate the impact of continuing medical education (CME) on the incidence of this disease.

METHODS

From 1990 to 2014, 1256 patients with achalasia were enrolled in this prospective study. A campaign of CME on diagnosis involving different regions of the country was conducted between 1999 and 2003. Annual incidence and prevalence were calculated by relating the number of diagnosed cases to 105 inhabitants. Each patient completed a standardized questionnaire, and underwent upper endoscopy, barium swallow and esophageal manometry. We systematically looked for Allgrove syndrome and familial achalasia.

RESULTS

The mean annual incidence raised from 0.04 (95%CI: 0.028-0.052) during the 1990s to 0.27/105 inhabitants/year (95%CI: 0.215-0.321) during the 2000s. The incidence of the disease was two and half times higher in the north and the center compared to the south of the country. One-hundred-and-twenty-nine (10%) were children and 97 (7.7%) had Allgrove syndrome. Familial achalasia was noted in 18 different families. Patients had dysphagia (99%), regurgitation (83%), chest pain (51%), heartburn 24.5% and weight loss (70%). The lower esophageal sphincter was hypertensive in 53% and hypotensive in 0.6%.

CONCLUSION

The mean incidence of achalasia in Algeria is at least 0.27/105 inhabitants. A good impact on the incidence of CME was noted. A gradient of incidence between different regions of the country was found. This variability is probably related to genetic and environmental factors. The discovery of an infantile achalasia must lead to looking for Allgrove syndrome and similar cases in the family.

Keywords: Achalasia; Incidence; Allgrove syndrome; Manometry; Continuing medical education

Core tip: The exact incidence of achalasia is unknown. Few epidemiological studies around the world have been devoted to it. The impact of continuing medical education (CME) on incidence of achalasia has not been evaluated. This study showed that CME has a positive effect on the incidence of this disease. In fact, the mean incidence raised from 0.04 (95%CI: 0.028-0.052) during the 1990s to 0.27/105 inhabitants/year (95%CI: 0.215-0.321) during the 2000s. This incidence was two and half times higher in the north and the center compared to the south of the country. This variability is probably related to genetic and environmental factors.