Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India.
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500032, Telangana, India.
World J Gastroenterol. 2024 Mar 7;30(9):1096-1107. doi: 10.3748/wjg.v30.i9.1096.
Achalasia cardia, the most prevalent primary esophageal motility disorder, is predominantly characterized by symptoms of dysphagia and regurgitation. The principal therapeutic approaches for achalasia encompass pneumatic dilatation (PD), Heller's myotomy, and the more recent per-oral endoscopic myotomy (POEM). POEM has been substantiated as a safe and efficacious modality for the management of achalasia. Although POEM demonstrates superior efficacy compared to PD and an efficacy parallel to Heller's myotomy, the incidence of gastroesophageal reflux disease (GERD) following POEM is notably higher than with the aforementioned techniques. While symptomatic reflux post-POEM is relatively infrequent, the significant occurrence of erosive esophagitis and heightened esophageal acid exposure necessitates vigilant monitoring to preclude long-term GERD-related complications. Contemporary advancements in the field have enhanced our comprehension of the risk factors, diagnostic methodologies, preventative strategies, and therapeutic management of GERD subsequent to POEM. This review focuses on the limitations inherent in the 24-h pH study for evaluating post-POEM reflux, potential modifications in the POEM technique to mitigate GERD risk, and the strategies for managing reflux following POEM.
贲门失弛缓症是最常见的原发性食管动力障碍，主要表现为吞咽困难和反流症状。贲门失弛缓症的主要治疗方法包括气囊扩张（PD）、Heller 肌切开术和最近的经口内镜肌切开术（POEM）。POEM 已被证实是治疗贲门失弛缓症的一种安全有效的方法。虽然 POEM 与 PD 相比具有更高的疗效，与 Heller 肌切开术的疗效相当，但 POEM 后胃食管反流病（GERD）的发生率明显高于上述两种技术。虽然 POEM 后症状性反流相对较少见，但腐蚀性食管炎的显著发生和食管酸暴露的增加需要进行密切监测，以防止长期 GERD 相关并发症。该领域的最新进展增强了我们对 POEM 后 GERD 的危险因素、诊断方法、预防策略和治疗管理的理解。本综述重点讨论了 24 小时 pH 研究在评估 POEM 后反流方面的局限性、POEM 技术的潜在改进以降低 GERD 风险，以及 POEM 后管理反流的策略。
