Tag Archives: squamous cell carcinoma

Achalasia and Risk of Esophageal Cancers

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W Leijonmarck et al. Gastroenterology 2026; 171: 481-488. Open Access! Achalasia and Risk of Esophageal Squamous Cell Carcinoma and Adenocarcinoma in a Multinational Study

Methods: “A population-based case–control study was conducted in 5 Nordic countries from 1987 to 2023. Esophageal cancer cases (n = 35,604) were matched to 10 times as many background population controls by age, sex, calendar year, and country (n = 355,869). Conditional logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for smoking and alcohol, and additionally for GERD in a mechanistic model. All variables came from national health data registries.” The registries used prospectively collected data.

Key findings:

  • Absolute numbers of esophageal cancer: “Achalasia was present in 137 cases (96 squamous cell carcinomas and 41 adenocarcinomas) and 230 controls (99 squamous cell carcinomas and 131 adenocarcinomas)”
  • “Achalasia was associated with a strongly increased risk of esophageal squamous cell carcinoma (OR, 9.46)”
  • A moderate association was found for esophageal adenocarcinoma (OR, 3.05). This association “became attenuated and nonsignificant after adjustment for GERD and even weaker in patients treated with myotomy or pneumatic dilation.” The discussion notes the following: “possible pathway to adenocarcinoma is iatrogenic reflux caused by myotomy or pneumatic dilation that destroys the antireflux function of the lower esophageal sphincter.6 Alternatively, low esophageal pH that leads to adenocarcinoma in the achalasia esophagus may result from impaired esophageal clearance, allowing refluxed acid to linger, or from lactic acid production due to the fermentation of stagnant food.5,26,27“

My take: An increased risk is another ‘tough pill to swallow’ when diagnosed with achalasia. However, the authors note that “despite the strong association, routine cancer surveillance endoscopy may still not be recommended due to the low proportion (<1%) of achalasia in esophageal cancer.” In those with worsening dysphagia, this infrequent complication needs to be considered.

Related blog posts:

Hallgrímskirkja, the largest church in Iceland, and the Statue of Leif Erikson standing directly in front of it in downtown Reykjavík. The concrete facade was inspired by the basalt lava rock columns found in Iceland.

IBD Updates November 2019

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M Lowenberg et al. Gastroenterol 2019; 157: 997-1006. This LOVE-CD study, a prospective study with 110 patients with active Crohn’s disease, found that treatment with vedolizumab resulted in 29% and 31% corticosteroid-free clinical remission at weeks 26 and 52 respectively (CDAI <150).  Endoscopic remission, based on intent-to-treat analysis, was 33% and 36% at weeks 26 and 52.  Serum vedolizumab levels above 10 mg/L at week 22 were associated with endoscopic remission at week 26.

S Danese et al. Gastroenterol 2019; 157: 1007-18.  This VERSIFY trial, a phase 3b, open-label, single-group study of 101 patients with Crohn’s disease, found that treatment with vedolizumab resulted in 11.9% and 17.9%  endoscopic remission at week 26 and 52 respectively. Remission by MRE was 21.9% and 38.1% at those respective time points. No notable safety issues were reported.

N Khan et al. Clin Gastroenterol 2019; 17: 2262-8. Using a retrospective cohort of 54,919 patients with IBD followed by the VA System (2000-2018), the authors identified 467 patients with incident squamous cell cancer (SCC); median age ~70 years.  11 patients with SCC died from related-complications.  In this group, 8 had been exposed to thiopurines.   Thus, exposure to thiopurines increased mortality related to SCC compared to those exposed to mesalamine therapy, though the absolute risk among the entire cohort was less than 1 in 5000.  My take: Long-term use of thiopurines should be paired with dermatology evaluation and good skin care.

Pics from Mechandise Mart Light Show, Chicago