{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T20:51:40Z","timestamp":1779310300002,"version":"3.51.4"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background and aim<\/jats:title>\n<jats:p>Achalasia represents a chronic motility disorder of the esophagus featuring an impaired lower esophageal sphincter relaxation and loss of esophageal peristalsis. By causing dysphagia, regurgitation, aspiration and chest pain, achalasia might tremendously affect life quality of patients. However, the impact of achalasia on the development of mood disorders including depression has largely remained unclear. The aim of this study was to evaluate the incidence of depression in achalasia patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We analyzed a large primary care cohort database in Germany capturing data from 7.49 million patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of n = 1,057 patients with achalasia diagnosed between January 2005 and December 2018 were matched to a cohort of n = 3,171 patients without achalasia controlling for age, sex, physician, index year, and the Charlson comorbidity index. Interestingly, while the frequency of depression prior to the diagnosis of achalasia was comparable in both groups, new diagnoses of depression were significantly higher within one year after the diagnosis of achalasia compared to the control group, suggesting a direct and previously unrecognized association between achalasia and depression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our data suggest that the clinical management of patients with achalasia should include a careful and structured work-up for mood disorders in order to improve long-term quality of life in these patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250503","type":"journal-article","created":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T17:42:49Z","timestamp":1619804569000},"page":"e0250503","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Achalasia is associated with a higher incidence of depression in outpatients in Germany"],"prefix":"10.1371","volume":"16","author":[{"given":"Sven H.","family":"Loosen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennis","family":"Kandler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Luedde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karel","family":"Kostev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1409-7697","authenticated-orcid":true,"given":"Christoph","family":"Roderburg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,30]]},"reference":[{"key":"pone.0250503.ref001","first-page":"71","article-title":"Clinical management of achalasia: Current state of the art","volume":"9","author":"JT Krill","year":"2016","journal-title":"Clinical and Experimental Gastroenterology"},{"key":"pone.0250503.ref002","doi-asserted-by":"crossref","first-page":"70","DOI":"10.14740\/gr723w","article-title":"Changing Trends in Age, Gender, Racial Distribution and Inpatient Burden of Achalasia","volume":"10","author":"V Wadhwa","year":"2017","journal-title":"Gastroenterology Research"},{"key":"pone.0250503.ref003","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1177\/2040622317710010","article-title":"Achalasia: current therapeutic options","volume":"8","author":"Z Arora","year":"2017","journal-title":"Therapeutic Advances in Chronic Disease"},{"key":"pone.0250503.ref004","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0025-6196(11)63127-3","article-title":"Primary Esophageal Motility Disorders","volume":"76","author":"DG Adler","year":"2001","journal-title":"Mayo Clinic Proceedings"},{"key":"pone.0250503.ref005","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1442-2050.2006.00569.x","article-title":"Achalasia: Physiology and etiopathogenesis","volume":"19","author":"RE Kraichely","year":"2006","journal-title":"Diseases of the Esophagus"},{"key":"pone.0250503.ref006","article-title":"Achalasia: Update on the disease and its treatment","author":"DL Francis","year":"2010","journal-title":"Gastroenterology"},{"key":"pone.0250503.ref007","first-page":"299","article-title":"Treatment of achalasia in the era of high-resolution manometry","volume":"28","author":"F Torresan","year":"2015","journal-title":"Annals of Gastroenterology"},{"key":"pone.0250503.ref008","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1056\/NEJMoa1010502","article-title":"Pneumatic Dilation versus Laparoscopic Heller\u2019s Myotomy for Idiopathic Achalasia","volume":"364","author":"GE Boeckxstaens","year":"2011","journal-title":"New England Journal of Medicine"},{"key":"pone.0250503.ref009","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/01.sla.0000114217.52941.c5","article-title":"Randomized Controlled Trial of Botulinum Toxin Versus Laparoscopic Heller Myotomy for Esophageal Achalasia","volume":"239","author":"G Zaninotto","year":"2004","journal-title":"Annals of Surgery"},{"key":"pone.0250503.ref010","first-page":"e6103","article-title":"Depression and Anxiety in Patients with Gastroesophageal Reflux Disorder With and Without Chest Pain","volume":"11","author":"S Mohammad","year":"2019","journal-title":"Cureus"},{"key":"pone.0250503.ref011","first-page":"479","article-title":"Correlations between depressive condition and gastroesophageal reflux symptoms in patients visiting a department of general medicine","volume":"73","author":"Y Suganami","year":"2019","journal-title":"Acta Medica Okayama"},{"key":"pone.0250503.ref012","doi-asserted-by":"crossref","first-page":"117","DOI":"10.5005\/jp-journals-10018-1230","article-title":"Psychological Results of 438 Patients with persisting Gastroesophageal Reflux Disease Symptoms by Symptom Checklist 90-Revised Questionnaire","volume":"7","author":"X Chen","year":"2017","journal-title":"Euroasian Journal of Hepato-Gastroenterology"},{"key":"pone.0250503.ref013","doi-asserted-by":"crossref","first-page":"617","DOI":"10.5414\/CPP47617","article-title":"Validity and representativeness of the \u201cDisease Analyzer\u201d patient database for use in pharmaco-epidemiological and pharmacoeconomic studies","volume":"47","author":"H Becher","year":"2009","journal-title":"Int Journal of Clinical Pharmacology and Therapeutics"},{"key":"pone.0250503.ref014","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5414\/CP203320","article-title":"Basic characteristics and representativeness of the German Disease Analyzer database","volume":"56","author":"W Rathmann","year":"2018","journal-title":"International Journal of Clinical Pharmacology and Therapeutics"},{"key":"pone.0250503.ref015","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1002\/hep4.1541","article-title":"Nonalcoholic Fatty Liver Disease Increases the Risk of Anxiety and Depression","volume":"4","author":"C Labenz","year":"2020","journal-title":"Hepatology Communications"},{"key":"pone.0250503.ref016","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"H Quan","year":"2005","journal-title":"Medical Care"},{"key":"pone.0250503.ref017","article-title":"Achalasia: physiology and diagnosis","author":"E Rieder","year":"2020","journal-title":"Annals of the New York Academy of Sciences"},{"key":"pone.0250503.ref018","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.phrs.2019.03.013","article-title":"Cholinergic system in sleep regulation of emotion and motivation","volume":"143","author":"P Mu","year":"2019","journal-title":"Pharmacological Research"},{"key":"pone.0250503.ref019","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1038\/s41398-020-01105-9","article-title":"Shared neuroimmune and oxidative pathways underpinning Chagas disease and major depressive disorder","volume":"10","author":"E Duarte-Silva","year":"2020","journal-title":"Translational Psychiatry"},{"key":"pone.0250503.ref020","first-page":"411","article-title":"An overview of Achalasia and its subtypes","volume":"13","author":"DA Patel","year":"2017","journal-title":"Gastroenterology and Hepatology"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250503","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T17:43:07Z","timestamp":1619804587000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250503"}},"subtitle":[],"editor":[{"given":"Kenji","family":"Hashimoto","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,30]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250503","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,30]]}}}