A study by Shiwaku and colleagues evaluated the risk factors and long-term course of reflux esophagitis and symptomatic gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM).

A multicenter cohort study was done involving 14 high volume centers. A total of 2905 patients with achalasia-related esophageal motility disorders treated with POEM underwent evaluation for reflux esophagitis, severe reflux esophagitis (Los Angeles classification C or D), and symptomatic GERD.

• Reflux esophagitis was present in 1886 patients (64.9%).
• Factors having an independent association with reflux esophagitis included age 65 years and above (risk ratio [RR] 0.85), being male (RR 1.11), posterior myotomy (RR 1.12), esophageal myotomy > 10 cm (RR 1.12), and gastric myotomy > 2 cm (RR 1.17).
• Overall, 219 patients (7.5%) had severe reflux esophagitis.
• Factors tied to severe reflux esophagitis included age 65 years and older (RR 1.72), previous treatments (RR 2.21), Eckardt score of 7 or more (RR 0.68), sigmoid-type achalasia (RR 1.40), and esophageal myotomy > 10 cm (RR 1.59).
• Proton pump inhibitors (PPIs) appeared to be more effective for reflux esophagitis at 5-year follow-up (P = 0.03) compared to 1 year (P = 0.08).
• Symptomatic GERD was evident in 458 patients (15.9 %).
• Factors tied to symptomatic GERD included symptom duration ≥ 10 years (RR 1.28), achalasia diagnosis (RR 0.68), integrated relaxation pressure ≥ 26 (RR 0.60), and posterior myotomy (RR 0.80).
• The incidence of symptomatic GERD was lower at 5-year follow-up in comparison with after 1 year (P = 0.04), more so in patients using PPIs (P < 0.001).

The study revealed that the incidence of severe reflux esophagitis was low after POEM; however, excessive myotomy for older individuals with previous treatments must be avoided.

Source: Shiwaku H, Sato H, Shimamura Y, et al. Risk factors and long-term course of gastroesophageal reflux disease after peroral endoscopic myotomy: A large-scale multicenter cohort study in Japan. Endoscopy. 2022 Feb 16.