title: Incidence, clinical features and para-clinical findings of achalasia in Algeria: Experience of 25 years.
abstract: OBJECTIVE
  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 105inhabitants. 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 0.27/105inhabitants/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%.
  
  
  CONCLUSIONS
  The mean incidence of achalasia in Algeria is at least 0.27/105inhabitants. 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.
authors: Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Nadia Oumnia, Internal Medicine Department, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria.
authors: Amar
authors: A
authors: Tebaibia
authors: Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Nadia Oumnia, Internal Medicine Department, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria.
authors: Mohammed Amine
authors: MA
authors: Boudjella
authors: Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Nadia Oumnia, Internal Medicine Department, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria.
authors: Djamel
authors: D
authors: Boutarene
authors: Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Nadia Oumnia, Internal Medicine Department, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria.
authors: Farouk
authors: F
authors: Benmediouni
authors: Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Nadia Oumnia, Internal Medicine Department, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria.
authors: Hakim
authors: H
authors: Brahimi
authors: Amar Tebaibia, Mohammed Amine Boudjella, Djamel Boutarene, Farouk Benmediouni, Nadia Oumnia, Internal Medicine Department, Kouba Hospital, University of Algiers 1, Algiers 16050, Algeria.
authors: Nadia
authors: N
authors: Oumnia
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000462:Algeria; D001464:Barium; D002648:Child; D002675:Child, Preschool; D004502:Education, Medical, Continuing; D004724:Endoscopy; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology*; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001464:Barium
keywords: Achalasia; Allgrove syndrome; Continuing medical education; Incidence; Manometry