Achalasia (primary esophageal motor disorder with impaired LES relaxation and loss of eso...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ACHALASIA-ESOPHAGEAL-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-ESOPHAGEAL`
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-ESOPHAGEAL-2025`

Red Flag Origin

Definition	Achalasia (primary esophageal motor disorder with impaired LES relaxation and loss of esophageal peristalsis, diagnosed by high-resolution manometry per Chicago classification) in an individual without a current esophageal cancer diagnosis. Long-standing chronic food stasis and esophagitis confer markedly elevated esophageal SCC risk (relative risk ~16-50x population baseline; absolute risk ~0.3-1%/year emerging 10-25 years after achalasia onset). Esophageal adenocarcinoma risk is also elevated in achalasia patients with secondary Barrett's after surgical or pneumatic myotomy. Endoscopic surveillance starting 10-15 years after achalasia diagnosis is the standard secondary-prevention strategy. Prevention-persona RedFlag (§20 ratification 2026-05-18, v0.3 chronic-condition pilot).
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "achalasia_diagnosis_confirmed",
      "value": true
    },
    {
      "finding": "achalasia_with_megaesophagus",
      "value": true
    },
    {
      "finding": "achalasia_post_myotomy_with_barretts",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

v0.3 chronic-condition prevention pilot — achalasia / esophageal SCC. Prevention-persona RedFlag (CHARTER §3 amended 2026-05-18 Path A, HCP-mediated). Fires when patient profile shows confirmed achalasia AND no confirmed esophageal cancer. Engine routes to PreventionPlan with 2 tracks: EGD q2-3y starting 10-15y after achalasia onset (IND-ACHALASIA-ESOPHAGEAL-PREVENTION-SURVEILLANCE) as standard; symptom-driven observation (IND-ACHALASIA-ESOPHAGEAL-PREVENTION- OBSERVATION) as alternative. Evidence base: - **SCC risk magnitude:** Sandler et al. JAMA 1995 (Mayo cohort, RR ~16); Leeuwenburgh et al. Am J Gastroenterol 2010 (Dutch national cohort, RR ~28). Latency 10-25y from achalasia onset to SCC emergence. - **Surveillance evidence:** prospective cohort data limited; ACG 2013 + ASGE 2015 recommend EGD surveillance q2-3y starting 10-15y after diagnosis, with biopsy of any suspicious mucosa. Cancer detected at earlier stage when found via surveillance vs symptomatic presentation (Leeuwenburgh 2010 — early-stage detection in 75% of surveilled vs 25% of unsurveilled). - **Post-myotomy Barrett:** ~25-30% develop reflux + Barrett within 10y after Heller myotomy or POEM; PPI co-therapy reco...

Used By

Indications

IND-ACHALASIA-ESOPHAGEAL-PREVENTION-OBSERVATION - IND-ACHALASIA-ESOPHAGEAL-PREVENTION-OBSERVATION
IND-ACHALASIA-ESOPHAGEAL-PREVENTION-SURVEILLANCE - IND-ACHALASIA-ESOPHAGEAL-PREVENTION-SURVEILLANCE