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Endoscopy 2020; 52(08): 643-651
DOI: 10.1055/a-1133-4354
Original article

Gastroesophageal reflux disease after peroral endoscopic myotomy is unpredictable, but responsive to proton pump inhibitor therapy: a large, single-center study

Zaheer Nabi
1   Department of Gastroenterologist, Asian Institute of Gastroenterology, Hyderabad, India
,
Mohan Ramchandani
1   Department of Gastroenterologist, Asian Institute of Gastroenterology, Hyderabad, India
,
Rama Kotla
2   Department of Anaesthesia, Asian Institute of Gastroenterology, Hyderabad, India
,
Manu Tandan
1   Department of Gastroenterologist, Asian Institute of Gastroenterology, Hyderabad, India
,
Rajesh Goud
1   Department of Gastroenterologist, Asian Institute of Gastroenterology, Hyderabad, India
,
Santosh Darisetty
2   Department of Anaesthesia, Asian Institute of Gastroenterology, Hyderabad, India
,
G. Venkat Rao
3   Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
D. Nageshwar Reddy
1   Department of Gastroenterologist, Asian Institute of Gastroenterology, Hyderabad, India
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Author commentary on Zaheer Nabi et al.Endoscopy 2020; 52(08): v28-v28
DOI: 10.1055/a-1147-7138

Abstract

Background Gastroesophageal reflux disease (GERD) is an important concern after peroral endoscopic myotomy (POEM). However, there are limited data on the risk factors for post-POEM GERD and its responsiveness to proton pump inhibitors (PPIs). In this study, we aimed to analyze the variables affecting the occurrence of GERD and its response to PPI therapy.

Methods Consecutive patients with idiopathic achalasia who underwent POEM (December 2016 to January 2018) were evaluated for GERD using 24-hour pH impedance, esophagogastroduodenoscopy (EGD), and symptoms. Multivariate analysis was performed to identify the variables affecting the incidence of post-POEM GERD.

Results A total of 209 patients with esophageal motility disorders, including 194 patients with non-sigmoid achalasia, underwent POEM during the study period. Comprehensive evaluation of GERD was completed on 167 patients (86.1 %): 47.3 % women with a mean (standard deviation) age of 41 (14.42) years and body mass index of 22.2 (3.89) kg/m2; the majority (70.7 %) were treatment naïve. A high DeMeester score (> 14.72), reflux esophagitis, and symptomatic GERD were identified in 47.9 %, 41.9 %, and 29.3 % of patients, respectively. On logistic regression analysis, type of achalasia, technique of POEM (anterior vs. posterior), pre- or post-POEM esophageal manometry variables, and patient characteristics were not associated with post-POEM GERD. Erosive esophagitis responded to PPI therapy in the majority of patients (81.4 %).

Conclusion The incidence of GERD is high after POEM. Most of the reflux esophagitis is mild and responsive to PPI therapy. There are no procedural or patient-related variables that appear to affect the incidence of post-POEM GERD.



Publication History

Received: 05 October 2019

Accepted: 17 February 2020

Article published online:
24 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

Refers to:

Is gastroesophageal reflux disease after peroral endoscopic myotomy a clinical problem?Endoscopy 2020; 52(08): 652-653
DOI: 10.1055/a-1185-9739

 

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