Xu Ying, Wang Yan, Bao Yun, Yu Ting, Tang Yurong, Lin Lin, Jiang Liuqin
Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Neurogastroenterol Motil. 2021 Jul 30;27(3):377-389. doi: 10.5056/jnm20041.
BACKGROUND/AIMS: Achalasia is a rare disease, but the incidence is increasing recently. Peroral esophageal myotomy (POEM) is an effective treatment. Regurgitation is a common symptom before and after POEM. Our aim is to investigate the factors related to preoperative and postoperative reflux symptoms.
Our study was retrospective. The achalasia patients diagnosed by high-resolution manometry and gastroscopy were divided into reflux group and non-reflux group before and after POEM, respectively. General information, symptoms, POEM information, and manometric results were compared.
(1) Ninety-six of 130 patients had reflux symptoms before POEM. The lower esophageal sphincter pressure (LESP) in the reflux group was significantly higher than the non-reflux group ( = 0.023), while integrated relaxation pressure (IRP) was similar. The reflux group had longer esophagus than the non-reflux group ( = 0.006). Reflux symptoms were not related to subtypes of achalasia. (2) Twenty-five of 84 patients had reflux symptoms after POEM. Postoperative Eckardt scores, LESP, and 4-second IRP (4sIRP) were significantly lower than the preoperative values ( < 0.001). The preoperative values and POEM information were similar between the postoperative 2 groups and there was no significant difference in the presence of preoperative reflux symptoms between 2 groups. The postoperative LESP and 4sIRP were similar between the 2 groups, however, the postoperative UESP was significantly higher in the reflux group than the non-reflux group ( = 0.042). The non-reflux group had more declines in Eckardt scores and LESP than the reflux group.
s The reflux symptoms of achalasia patients without treatment were mainly due to food retention. The postoperative reflux symptoms were not the sign of the excessive relaxation of lower esophageal sphincter.
背景/目的：贲门失弛缓症是一种罕见疾病，但近年来发病率呈上升趋势。经口内镜下食管肌切开术（POEM）是一种有效的治疗方法。反流是POEM术前和术后的常见症状。我们的目的是研究与术前和术后反流症状相关的因素。
我们的研究是回顾性的。经高分辨率测压和胃镜诊断的贲门失弛缓症患者在POEM术前和术后分别分为反流组和无反流组。比较两组患者的一般信息、症状、POEM相关信息和测压结果。
（1）130例患者中有96例在POEM术前有反流症状。反流组的食管下括约肌压力（LESP）显著高于无反流组（P = 0.023），而综合松弛压（IRP）相似。反流组的食管长度比无反流组更长（P = 0.006）。反流症状与贲门失弛缓症的亚型无关。（2）84例患者中有25例在POEM术后有反流症状。术后Eckardt评分、LESP和4秒综合松弛压（4sIRP）均显著低于术前值（P < 0.001）。术后两组的术前值和POEM相关信息相似，两组术前反流症状的存在情况无显著差异。两组术后的LESP和4sIRP相似，然而，反流组术后的UESP显著高于无反流组（P = 0.042）。无反流组Eckardt评分和LESP的下降幅度比反流组更大。
未经治疗的贲门失弛缓症患者的反流症状主要是由于食物潴留。术后反流症状并非食管下括约肌过度松弛的表现。
