Itskoviz D, Malnick SDH. Gastroesophageal reflux following peroral endoscopic myotomy for achalasia: Bumps in the road to success. World J Gastroenterol 2024; 30(29): 3461-3464 [DOI: 10.3748/wjg.v30.i29.3461]
Corresponding Author of This Article
David Itskoviz, MD, Doctor, Kaplan Medical Center, Institute of Gastroenterology and Hepatology, Hebrew University Medical School of Jerusalem, Pasternak Street, Rehovot 76100, Israel. dudyi@clalit.org.il
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 7, 2024; 30(29): 3461-3464 Published online Aug 7, 2024. doi: 10.3748/wjg.v30.i29.3461
Gastroesophageal reflux following peroral endoscopic myotomy for achalasia: Bumps in the road to success
David Itskoviz, Stephen David Howard Malnick
David Itskoviz, Kaplan Medical Center, Institute of Gastroenterology and Hepatology, Hebrew University Medical School of Jerusalem, Rehovot 76100, Israel
Stephen David Howard Malnick, Kaplan Medical Center, Department of Internal Medicine C, Hebrew University Medical School of Jerusalem, Rehovot 76100, Israel
Author contributions: Itskoviz D reviewed the literature and wrote the editorial draft; Malnick SDH reviewed the literature, and reviewed and edited the manuscript.
Conflict-of-interest statement: The authors do not have any conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: David Itskoviz, MD, Doctor, Kaplan Medical Center, Institute of Gastroenterology and Hepatology, Hebrew University Medical School of Jerusalem, Pasternak Street, Rehovot 76100, Israel. dudyi@clalit.org.il
Received: March 10, 2024 Revised: May 16, 2024 Accepted: July 10, 2024 Published online: August 7, 2024 Processing time: 140 Days and 19.6 Hours
Abstract
Achalasia can significantly impair the quality of life. The clinical presentation typically includes dysphagia to both solids and liquids, chest pain, and regurgitation. Diagnosis can be delayed in patients with atypical presentations, and they might receive a wrong diagnosis, such as gastroesophageal reflux disease (GERD), owing to overlapping symptoms of both disorders. Although the cause of achalasia is poorly understood, its impact on the motility of the esophagus and gastroesophageal junction is well established. Several treatment modalities have been utilized, with the most common being surgical Heller myotomy with concomitant fundoplication and pneumatic balloon dilatation. Recently, peroral endoscopic myotomy (POEM) has gained popularity as an effective treatment for achalasia, despite a relatively high incidence of GERD occurring after treatment compared to other modalities. The magnitude of post-POEM GERD depends on its definition and is influenced by patient and procedure-related factors. The long-term sequelae of post-POEM GERD are yet to be determined, but it appears to have a benign course and is usually manageable with clinically available modalities. Identifying risk factors for post-POEM GERD and modifying the POEM procedure in selected patients may improve the overall success of this technique.
Core Tip: Peroral endoscopic myotomy (POEM) is a valuable treatment for achalasia, although the occurrence of gastroesophageal reflux disease (GERD) following this procedure is a major concern among patients and caregivers. In this editorial, we will address the true meaning of acidic reflux after POEM, discuss the factors that need to be taken into account to prevent post-POEM GERD, and outline the treatment options available when it occurs.
