S1001 Increasing Incidence of Achalasia in the United States Between 2014-2024: A TriNetX Study

Introduction: Achalasia is a rare esophageal motility disorder characterized by failed peristalsis and inadequate relaxation of the lower esophageal sphincter. Given the rarity of this condition, its epidemiology is not well defined, although a few studies in specific populations suggest that the incidence of achalasia is on the rise. The aim of this study was to examine the epidemiology of achalasia using a large national, population-based database. Methods: Data on patients with achalasia was extracted from the TriNetX database, a composite of electronic health records from 66 healthcare organizations, between January 2014 and December 2024. Achalasia was defined using International Classification of Diseases-10 (K22.0) code and patients were required to have Current Procedural Terminology code (91010 and 91013) for high-resolution esophageal manometry (HRM) prior to achalasia diagnosis. Data was extracted on patient demographics including age, sex, race, and ethnicity. Negative binomial regression was used to evaluate trends. Results: A total of 17,377 patients were diagnosed with achalasia between 2014-2024 (mean age 57.6±17.8 years, 52.3% women, and 64.4% White). The overall incidence of achalasia increased from 0.86% in 2014 to 1.66% in 2024. The incidence of achalasia between 2014-2024 increased among all age groups (age 18-49 years, 0.82% to 1.84%; age ≥50 years, 0.87% to 1.58%) as well as in both men (1.26% to 2.57%) and women (0.73% to 1.35%). Furthermore, the incidence increased among all races (White [0.77% to 1.64%], African American [1.11% to 1.76%], and Asian [0.51% to 2.07%]) and ethnicities (Hispanic/Latino [0.86% to 1.81%] and Non-Hispanic/Latino [0.89% to 1.63%]) during the study period. Conclusion: In this large national, population-based study utilizing data from the TriNetX database, we demonstrate a 2-fold increase in incidence of achalasia in the United States over the past decade. The increase in incidence was seen both overall and among different subgroups including age, sex, race, and ethnicity. The increase in achalasia incidence may be, in part, due to advancements in HRM and adoption of better diagnostic criteria during the study period. However, additional studies are needed to better elucidate the factors contributing to the increase in achalasia diagnosis.