PMID- 34390053
OWN - NLM
STAT- MEDLINE
DCOM- 20220120
LR  - 20220516
IS  - 1443-1661 (Electronic)
IS  - 0915-5635 (Linking)
VI  - 34
IP  - 2
DP  - 2022 Jan
TI  - Post-per-oral endoscopic myotomy heartburn: It's not always reflux: Expert 
      review.
PG  - 325-333
LID - 10.1111/den.14106 [doi]
AB  - Patients with achalasia frequently develop gastroesophageal reflux (GER)-related 
      symptoms and complications after per-oral endoscopic myotomy (POEM). Reflux 
      symptoms are thought to be due to GER and the current treatment of post-POEM GER 
      focuses on acid suppression with proton pump inhibitors (PPI). However, reflux 
      symptoms in achalasia patients post-POEM can be due to true reflux, nonreflux 
      esophageal acidification due to stasis or acid fermentation, or esophageal 
      hypersensitivity to chemical or mechanical stimuli. True acidic reflux is not 
      always the cause of reflux symptoms. Twenty-four-hour pH monitoring with 
      impedance is essential to differentiate causes of esophageal acidification. PPI 
      is useful only in true acidic reflux. Detection of acid fermentation requires 
      manual review of a 24-h pH study, as automated review often overestimates acid 
      exposure time due to its inability to differentiate true reflux from 
      fermentation. Stasis of ingested acidic food warrants evaluation of esophageal 
      emptying by timed barium esophagogram. In cases of inadequate emptying, 
      esophagogastric junction (EGJ) distensibility can be evaluated by a functional 
      lumen imaging probe. Impaired distensibility with inadequate esophageal emptying 
      suggests treatment failure and may require retreatment. In treatment-refractory 
      patients, esophageal hypersensitivity should be considered and treated with 
      neuromodulators. Thus, the diagnostic approach to post-POEM reflux symptoms 
      should evolve to identify various patterns of esophageal acidification, 
      esophageal emptying patterns, EGJ distensibility, and hypersensitivity. 
      Consequently, the treatment of GER post-POEM should not be limited to treating 
      esophageal acidification by reflux, but should encompass other causes of 
      acidification and esophageal hypersensitivity.
CI  - (c) 2021 Japan Gastroenterological Endoscopy Society.
FAU - Ramchandani, Mohan
AU  - Ramchandani M
AD  - Asian Institute of Gastroenterology, Hyderabad, India.
FAU - Pal, Partha
AU  - Pal P
AD  - Asian Institute of Gastroenterology, Hyderabad, India.
FAU - Singla, Neeraj
AU  - Singla N
AD  - Asian Institute of Gastroenterology, Hyderabad, India.
FAU - Reddy, D Nageshwar
AU  - Reddy DN
AD  - Asian Institute of Gastroenterology, Hyderabad, India.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210901
PL  - Australia
TA  - Dig Endosc
JT  - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy 
      Society
JID - 9101419
SB  - IM
CIN - Dig Endosc. 2022 May;34(4):747-749. PMID: 35238420
MH  - *Esophageal Achalasia
MH  - Esophagogastric Junction
MH  - *Gastroesophageal Reflux/diagnosis/etiology
MH  - Heartburn/diagnosis/etiology
MH  - Humans
MH  - *Myotomy
MH  - *Natural Orifice Endoscopic Surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - esophageal achalasia
OT  - esophageal pH monitoring
OT  - gastroesophageal reflux disease
OT  - per oral endoscopic myotomy
EDAT- 2021/08/15 06:00
MHDA- 2022/01/21 06:00
CRDT- 2021/08/14 06:32
PHST- 2021/06/30 00:00 [received]
PHST- 2021/08/10 00:00 [accepted]
PHST- 2021/08/15 06:00 [pubmed]
PHST- 2022/01/21 06:00 [medline]
PHST- 2021/08/14 06:32 [entrez]
AID - 10.1111/den.14106 [doi]
PST - ppublish
SO  - Dig Endosc. 2022 Jan;34(2):325-333. doi: 10.1111/den.14106. Epub 2021 Sep 1.