Effect of Peroral Endoscopic Myotomy on Reflux Symptoms in Patients With Achalasia / 胃肠病学

ABSTRACT

Background: Achalasia patients may have reflux symptoms before and after peroral endoscopic myotomy (POEM), the mechanism is not completely consistent. Aims: To investigate the effect of POEM on reflux symptoms in patients with achalasia. Methods: Eighty-four achalasia patients underwent POEM from May 2011 to July 2018 at the First Affiliated Hospital of Nanjing Medical University were enrolled. According to whether they had reflux symptoms before or after POEM, the patients were divided into preoperative reflux group, preoperative non-reflux group or postoperative reflux group, and postoperative non-reflux group. Symptoms and parameters of high-resolution manometry before or after POEM were compared, respectively. Results: After POEM, the lower esophageal sphincter pressure (LESP), integrated relaxation pressure (IRP), Eckardt score in patients with achalasia were significantly decreased (P<0.05). Compared with preoperative non-reflux group, length of esophagus was significantly longer (P<0.001) and postoperative Eckardt score was significantly decreased (P=0.039) in preoperative reflux group. However, no significant differences in preoperative or postoperative LESP and IRP were found between the two groups. No significant differences in the incidence of preoperative reflux, postoperative LESP and IRP were found between postoperative reflux group and postoperative non-reflux group. Conclusions: The preoperative reflux symptom of achalasia patients may be caused by retention of food in esophagus. The preoperative reflux symptom may predict the better efficacy of POEM. Postoperative reflux symptom may be not correlated with LESP, but related with dysmotility of esophageal body or esophageal hypersensitivity.