title: Achalasia-an unnecessary long way to diagnosis.
abstract: Although achalasia presents with typical symptoms such as dysphagia, regurgitation, weight loss, and atypical chest pain, the time until first diagnosis often takes years and is frustrating for patients and nevertheless associated with high costs for the healthcare system. A total of 563 patients were interviewed with confirmed diagnosis of achalasia regarding their symptoms leading to diagnosis along with past clinical examinations and treatments. Included were patients who had undergone their medical investigations in Germany. Overall, 527 study subjects were included (male 46%, female 54%, mean age at time of interview 51 ± 14.8 years). Dysphagia was present in 86.7%, regurgitation in 82.9%, atypical chest pain in 79%, and weight loss in 58% of patients before diagnosis. On average, it took 25 months (Interquartile Range (IQR) 9-65) until confirmation of correct diagnosis of achalasia. Though, diagnosis was confirmed significantly quicker (35 months IQR 9-89 vs. 20 months IQR 8-53; p < 0.01) in the past 15 years. The majority (72.1%) was transferred to three or more specialists. Almost each patient underwent at least one esophagogastroduodenoscopy (94.2%) and one radiological assessment (89.3%). However, esophageal manometry was performed in 70.4% of patients only. The severity of symptoms was independent with regard to duration until first diagnosis (Eckardt score 7.14 ± 2.64 within 12 months vs. 7.29 ± 2.61 longer than 12 months; P = 0.544). Fifty-five percent of the patients primarily underwent endoscopic dilatation and 37% a surgical myotomy. Endoscopic dilatation was realized significantly faster compared to esophageal myotomy (1 month IQR 0-4 vs. 3 months IQR 1-11; p < 0.001). Although diagnosis of achalasia was significantly faster in the past 15 years, it still takes almost 2 years until the correct diagnosis of achalasia is confirmed. Alarming is the fact that although esophageal manometry is known as the gold standard to differentiate primary motility disorders, only three out of four patients had undergone this diagnostic pathway during their diagnostic work-up. Better education of medical professionals and broader utilization of highly sensitive diagnostic tools, such as high-resolution manometry, are strictly necessary in order to correctly diagnose affected patients and to offer therapy faster.
authors.affiliation: Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Niebisch
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Mainz Medical Center, Mainz, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Hadzijusufovic
authors.affiliation: Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mehdorn
authors.affiliation: Department of Gastroenterorlogy, DKD (German Diagnostic Clinic) Helios Clinic, Wiesbaden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Scheuermann
authors.affiliation: Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Lyros
authors.affiliation: Department of Surgery, EvK (Protestant Hospital) Castrop-Rauxel, Castrop-Rauxel, Germany.
authors.forename: H G
authors.initials: HG
authors.lastname: Schulz
authors.affiliation: Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Jansen-Winkeln
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Mainz Medical Center, Mainz, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.affiliation: Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Gockel
mesh_terms: D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000191:economics; D004945:Esophagoscopy; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D063189:Symptom Assessment / Q000191:economics / Q000379:methods*; D013997:Time Factors
keywords: achalasia; esophageal high-resolution manometry; time to diagnosis