Nabi Zaheer, Ramchandani Mohan, Kotla Rama, Tandan Manu, Goud Rajesh, Darisetty Santosh, Rao G Venkat, Reddy D Nageshwar
Department of Gastroenterologist, Asian Institute of Gastroenterology, Hyderabad, India.
Department of Anaesthesia, Asian Institute of Gastroenterology, Hyderabad, India.
Endoscopy. 2020 Aug;52(8):643-651. doi: 10.1055/a-1133-4354. Epub 2020 Mar 24.
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.
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.
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/m; 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 %).
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.
经口内镜下肌切开术（POEM）后，胃食管反流病（GERD）是一个重要问题。然而，关于POEM术后GERD的危险因素及其对质子泵抑制剂（PPI）反应性的数据有限。在本研究中，我们旨在分析影响GERD发生及其对PPI治疗反应的变量。
对2016年12月至2018年1月期间连续接受POEM治疗的特发性贲门失弛缓症患者，采用24小时pH阻抗监测、食管胃十二指肠镜检查（EGD）和症状评估GERD情况。进行多变量分析以确定影响POEM术后GERD发生率的变量。
在研究期间，共有209例食管动力障碍患者接受了POEM治疗，其中包括194例非乙状结肠型贲门失弛缓症患者。对167例患者（86.1%）完成了GERD的综合评估：47.3%为女性，平均（标准差）年龄为41（14.42）岁，体重指数为22.2（3.89）kg/m²；大多数（70.7%）患者未接受过治疗。分别有47.9%、41.9%和29.3%的患者DeMeester评分较高（>14.72）、存在反流性食管炎和有症状的GERD。经逻辑回归分析，贲门失弛缓症类型、POEM技术（前位与后位）、POEM术前或术后食管测压变量以及患者特征与POEM术后GERD无关。大多数患者（81.4%）的糜烂性食管炎对PPI治疗有反应。
POEM术后GERD的发生率较高。大多数反流性食管炎症状较轻，对PPI治疗有反应。似乎没有手术相关或患者相关变量会影响POEM术后GERD的发生率。
