title: Gastroesophageal reflux disease after peroral endoscopic myotomy: Analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis.
abstract: OBJECTIVE
  Peroral endoscopic myotomy (POEM) does not include any antireflux procedure, resulting in a certain risk of iatrogenic gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the incidence of iatrogenic GERD after POEM and identify preoperative, perioperative and postoperative factors associated with GERD.
  
  
  METHODS
  All patients treated at a single center who had a complete GERD evaluation after POEM were included in the study. Demographics, preoperative and follow-up data, results of functional studies and procedural data were collected and analyzed.
  
  
  RESULTS
  A total of 103 patients (mean age 46.6 years, 47 males) were included. Postoperative altered esophageal acid exposure was attested in 52 patients (50.5%). A total of 19 patients (18.4%) had heartburn and 21 had esophagitis (20.4%). Overall, a clinically relevant GERD (altered esophageal acid exposure, associated with heartburn and/or esophagitis) was diagnosed in 30 patients (29.1%). Correlation between the severity of esophageal acid exposure with heartburn and esophagitis after POEM was found. Patients with heartburn had a lower postoperative 4-second integrated relaxation pressure compared to patients without symptoms (7.6 ± 3.8 mmHg vs 10.01 ± 4.4 mmHg, p<0.05). No correlations were identified with patient sex, age, postoperative body mass index, esophageal shape (sigmoid vs non sigmoid), lower esophageal sphincter pressure, length of myotomy, previous therapies and type of achalasia at high-resolution manometry.
  
  
  CONCLUSIONS
  Preoperative, perioperative or postoperative factors minimally correlated with GERD after POEM. Clinically relevant GERD was identified in less than one-third of patients, but all patients were well controlled with medical therapy.
authors.affiliation: Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Familiari
authors.affiliation: Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Greco
authors.affiliation: Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gigante
authors.affiliation: Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Calì
authors.affiliation: Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Ivo
authors.initials: I
authors.lastname: Boškoski
authors.affiliation: Department of Geriatrics, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.affiliation: Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Perri
authors.affiliation: Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D050782:Esophageal pH Monitoring / Q000379:methods; D004941:Esophagitis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011183:Postoperative Complications; D011312:Pressure; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: achalasia; esophageal manometry; esophageal motility disorder; gastroesophageal reflux disease (GERD); peroral endoscopic myotomy (POEM)