IDDF2022-ABS-0042 Comprehensive analysis of nutritional parameters in patients with idiopathic achalasia: a prospective study

BackgroundCases with achalasia are at significant risk of malnourishment. In this study, we aimed to perform a comprehensive nutritional assessment of untreated cases with achalasia and compare them with cases with functional bowel diseases.MethodsThis is a prospective study including consecutive cases diagnosed with achalasia at a tertiary care centre (December 2021 to April 2022). Nutritional assessment was performed using biochemical parameters (hemoglobin, serum albumin, serum pre-albumin, serum iron, serum calcium, serum vitamin D and B12), triceps fold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), hand grip strength. Subjective global assessment (SGA) was used to characterize these patients into well nourished, moderately malnourished and severely malnourished groups. Cases diagnosed as functional bowel diseases matched for age and gender served as controls. Multivariate analysis was performed to assess the risk factors for malnourishment in cases with achalasia.Results118 cases (41.2±13.9 years, 61% males) with achalasia were compared with 200 matched controls. Subtypes of achalasia included type I (16.9%), II (76.3%) and III (6.8%). Overall, 53 (44.9%) cases with achalasia were moderately (38.1%) or severely (6.8%) malnourished. Mean Eckardt score was significantly higher in the malnourished cases (6.8±1.8 vs 5.9±1.8; p=0.014). Proportion of malnourished patients was significantly higher in type I as compared to type III (60% vs 14.3%; p=0.038) achalasia. As compared to controls, the mean values were significantly lower in cases with achalasia for serum albumin (4.3 vs 4.7; p-0.024), pre-albumin (19.4 vs 25.2; p=0.001), serum calcium (8.6 vs 9.7; p=0.012), vitamin D (17.6 vs 25.2; p=0.001), serum iron (58.2 vs 78.4; p=0.001), TSF(9.2 vs 10.2; p=0.002) and hand grip strength (21.5 vs 27.4; p=0.001). On multivariate analysis, symptom severity (Eckardt score) was a significant predictor of malnourishment in cases with achalasia.ConclusionsCases with achalasia are at significant risk of malnourishment as compared to those with functional bowel diseases. Increased symptom severity is an independent risk factor for malnourishment in these cases. (NCT05161923)