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

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-ACHALASIA-ESOPHAGEAL-PREVENTION`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-18 \| очікує клінічного підпису
Хвороби	`DIS-ESOPHAGEAL`
Джерела	`SRC-NCCN-BCELL-2025` `SRC-NCCN-ESOPHAGEAL-2025`

Походження тривожної ознаки

Визначення	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).
Клінічний напрям	investigate
Категорія	other

Логіка спрацьовування

{
  "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"
}

Нотатки

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...

Де використовується

Indications

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