Association between gastroesophageal reflux disease after pneumatic balloon dilatation and clinical course in patients with achalasia.
OBJECTIVE
The occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esoph-ageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilata-tion (PD) has a prognostic role and to investigate how the clinical course of GERD is.


METHODS
A total of 79 consecutive patients who were first diagnosed with primary achalasia and underwent PD as an initial treatment were included in this retrospective study. Single PD was performed using a 3.0 cm balloon. The patients were divided into two groups: 1) who developed GERD after PD (GERD group) and 2) who did not develop GERD after PD (non-GERD group). GERD was defined as pathological acid exposure, reflux esophagitis or typical reflux symptoms.


RESULTS
Twenty one patients (26.6%) developed GERD after PD during follow-up. There were no significant differences between the two groups in demographic or clinical factors including pre- and post-treatment manometric results. All patients in GERD group were well responsive to maintenance proton pump inhibitor therapy including on demand therapy or did not require maintenance. During a median follow-up of 17.8 months (interquartile range, 7.1-42.7 months), achalasia recurred in 15 pa-tients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD.


CONCLUSIONS
GERD often occurs after even a single PD for achalasia. However, GERD after PD is well responsive to PPI therapy. Our data suggest that GERD after PD during follow-up does not appear to have a prognostic role.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Yang Won
YW
Min
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jin Hee
JH
Lee
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Byung-Hoon
BH
Min
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jun Haeng
JH
Lee
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jae J
JJ
Kim
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Poong-Lyul
PL
Rhee
Gastroesophageal reflux; Pneumatic balloon dilatation; Prognosis; sophageal achalasia