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OBJECTIVE: Occasionally, patients with eating disorders have been subsequently diagnosed with esophageal achalasia. We sought to establish whether eating disorders and achalasia coexisted more often than expected by chance alone. METHOD: National record-linkage study of hospital inpatients in England, between 2001 and 2017. Use of Cox proportional hazards to compare the occurrence of achalasia in cohorts of people with or without anorexia nervosa (AN), and with or without bulimia nervosa (BN), with adjustment of the comparisons for such confounders as age, sex, and year of admission. RESULTS: There were 18,500 people in the AN cohort, 11,300 in the BN cohort, and 8.7 million in the comparison cohort. The Cox regression hazard ratio, comparing the AN cohort with the reference cohort, was 3.4 (95% confidence interval 1.8-6.3) and that in the BN cohort was 4.2 (2.2-8.2). DISCUSSION: AN and achalasia, and BN and achalasia, were diagnosed in the same individuals, more often than expected by chance. Clinicians should be aware of the possible associations with achalasia because the treatment of eating disorders and achalasia is different.

Original publication




Journal article


Int J Eat Disord

Publication Date





2015 - 2018


achalasia of the cardia, anorexia nervosa, association, big data, bulimia nervosa, comorbidity, epidemiology, esophageal achalasia, feeding and eating disorders, medical record linkage, medical records, Anorexia Nervosa, Bulimia Nervosa, Cohort Studies, Esophageal Achalasia, Hospitalization, Humans