Achalasia as a side effect - ehealthme

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I found a site that uses FDA data from reports of problems reported for

people taking drugs to generate reports for a condition and what drugs

were reported in association with that condition. I had done a Google

search and was getting a lot of hits titled something like " Does ....

cause oesophageal achalasia? " They all were from the same site and the

drugs appeared to have nothing in common with each other or achalasia. I

though it was some kind of scam and had to check it out. At first I

thought the data for achalasia was useless but then it occurred to me

that is may be useful as a negative result for illuminating some flaws

in common thinking.

Take a look at this, two pages of drugs for which people reported

achalasia in association with taking the drugs:

http://www.ehealthme.com/symptom/oesophageal+achalasia

Remember that the incidence rate of achalasia is 1 new case per 100,000

people per year. (The prevalence is 1 in 10,000). So, if you have a

large enough group, say several hundred thousand or more, you will have

some of them getting achalasia each year. With medications the

population in question would be the number of people at any given time

that are taking it. Take Nexium for example. I don't know specifically

how many people at any given time are taking it but it produced billions

of dollars in sales each year. Even at $5 a pill there could have been

enough for a million people at a time to be taking it. For each million

you would expect about 10 new cases of achalasia a year just by chance.

If you go to page 2 of the link above you will see that Nexium is listed

with 14 reports of achalasia. If you click on the link for Nexium it

takes you here:

http://www.ehealthme.com/ds/nexium/oesophageal+achalasia

You will see that there are only 4 years where achalasia reports were

made. Years where there were no achalasia reports made were not shown.

There is no data for 2011 and 2012. If you compare that page to:

http://www.ehealthme.com/q/nexium-side-effects-drug-interactions

You can see that reports for Nexium go back to 1999 for reports of other

types of possible side effects. This means that for most years no one

reported achalasia in association with Nexium use. The most associations

with achalasia, 8, were reported in 2009 but 2008 had none and 2010 had

only 3. Not very many for millions of users. On the other hand out of

the millions of users less than 46,000 reported any problems over all

the years. Out of 46,000 14 may seem a little high, but you have to

remember that often people with achalasia are first thought to have GERD

not achalasia and are put on PPIs, often Nexium, until they find out

they actually had achalasia. This situation could get reported as an

association of achalasia with Nexium use.

The data is too messy to draw a firm conclusion but you would not have

to conclude that there is any real causal association between Nexium and

achalasia to justify the numbers. The same is likely true of the other

medications. Some people who develop achalasia will be using medications

when that happens because a lot of people at any time are using

medications and by chance some of them will develop achalasia. The two

pages of drugs are those that by chance were being taken when people

developed achalasia not that they actually caused achalasia. However, if

someone was taking one of these drugs when achalasia developed it may be

hard to convince them the drug didn't cause it because that is the way

are minds work.

The same is true of many things in our lives, chicken pox, shingles,

dental work, stress, trauma and you name it. Our group is large enough

that some in it will have a connection to these things but the

connection between them and achalasia is probably just chance.

notan