Incidence and Predictors of Reflux Esophagitis Following Per-oral Endoscopic Myotomy: A Two-Year Prospective Study

Peroral endoscopic myotomy (POEM) is a highly effective treatment option for achalasia cardia. However, lack of an anti-reflux mechanism predisposes patients to gastroesophageal reflux disease (GERD). This study was undertaken to assess the incidence of reflux esophagitis two years post POEM and to identify predictive factors associated with GERD development.

Consecutive patients who underwent POEM at our institution between July 2021 and December 2021 were prospectively studied to assess the incidence and predictors of GERD. Subjective GERD was evaluated using a validated questionnaire, while objective GERD was determined using PH impedance (AET > 6% or reflux) and esophagogastroduodenoscopy.

Fifty four patients with achalasia cardia, underwent POEM during the study period. Evaluation of GERD was completed on 50 patients (92.5%).The majority of patients were treatment-naive (90%) and diagnosed with either type II achalasia (86%) or type I achalasia (14%). GERD was identified by pH impedance in 42%, by reflux esophagitis during endoscopy in 14%, and by symptomatic GERD in 18% of patients. Among these cases, 8 (16%) exhibited acidic reflux, while 13 (26%) demonstrated non-acidic reflux. An elevated acid exposure time (AET > 6%) was recorded in 11 patients (22%). The majority of cases were mild and non-erosive, with non-acidic reflux.

At two-year follow-up, objective GERD was more prevalent than symptomatic GERD following POEM, with rates comparable to laparoscopic Heller myotomy (LHM). Most cases were mild and non-acidic. No significant demographic or procedural predictors for symptomatic GERD were identified.