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Achalasia Patients Are at Nutritional Risk Regardless of Presenting Weight Category

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Abstract

Background

Achalasia is an esophageal motor disorder that leads to swallowing dysfunction and weight loss. Nutritional risk in achalasia patients is not well defined.

Aims

The aims of this study were to define baseline body mass index (BMI), changes in weight, and nutritional risk over time in a large cohort of achalasia patients.

Methods

This was a retrospective cohort study of achalasia patients at a tertiary care center with documented BMI, symptom severity as per Eckardt score, and nutritional risk assessment as per the Malnutrition Universal Screening Tool, which considers BMI, degree of recent weight loss, and acuity of disease.

Results

Among the 337 patients presenting for achalasia management, 179 had confirmed disease. Upon presentation 69.8% of patients were classified as overweight or obese. Using the Malnutrition Universal Screening Tool, we found 50% of patients to be at moderate or high risk for malnutrition at presentation. Eckardt score (OR 1.15, 95% CI 1.05–1.26), duration of disease (OR for each additional month 1.04, 95% CI 1.01–1.08), and female gender (OR 1.76, 95% CI 1.02–3.03) were independent predictors of increased risk for malnutrition. Nutrition risk score decreased after therapy in 93.3% of patients.

Conclusions

Despite a high prevalence of overweight and obese status in achalasia patients, many are at risk of developing nutritional complications secondary to rapid weight loss. This risk frequently resolves post-treatment. Regardless of baseline BMI, we recommend all patients undergo nutritional assessment to identify high-risk patients who may benefit from dietary intervention and expedited therapy.

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Authors and Affiliations

  1. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, 7th Floor, South Tower, Philadelphia, PA, 19104, USA

    Carolyn Newberry, Ravy K. Vajravelu, Octavia Pickett-Blakely, Gary Falk, Yu Xiao Yang & Kristle L. Lynch

  2. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, 733 Blockley Hall, Philadelphia, PA, 19104, USA

    Yu Xiao Yang

Authors
  1. Carolyn Newberry
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  2. Ravy K. Vajravelu
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  3. Octavia Pickett-Blakely
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  4. Gary Falk
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  5. Yu Xiao Yang
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  6. Kristle L. Lynch
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Contributions

CN was involved in the study design, data collection, data interpretation, and manuscript preparation. RV was involved in data analysis, interpretation, and content of the manuscript. OP-B was involved in the manuscript preparation. GF was involved in the data interpretation and manuscript preparation. YXY was involved in the data analysis, interpretation, and content of the manuscript. KL was involved in the study design, data interpretation, and manuscript preparation.

Corresponding author

Correspondence to Carolyn Newberry.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Newberry, C., Vajravelu, R.K., Pickett-Blakely, O. et al. Achalasia Patients Are at Nutritional Risk Regardless of Presenting Weight Category. Dig Dis Sci 63, 1243–1249 (2018). https://doi.org/10.1007/s10620-018-4985-8

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  • DOI: https://doi.org/10.1007/s10620-018-4985-8

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