24‐h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy

Novais, Paula; Lemme, Eponina

doi:10.1111/j.1365-2036.2010.04461.x

Cited by 98 publications

(47 citation statements)

References 38 publications

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“…Though this method effectively relieves the obstruction, it also increases the risk of gastroesophageal reflux, and most surgeons incorporate an anti-reflux procedure by way of a partial fundoplication [33,34]. Studies initially showed superiority of surgical myotomy in terms of efficiency and durability compared to single balloon dilatation [35,36]. Further comparison of these two modalities has shown similar outcomes in treatment success rates after 2-year follow-up when a graded approach to PD has been used [32,37,38].…”

Section: Treatmentmentioning

confidence: 91%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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Section: Treatmentmentioning

confidence: 91%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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“…Current standard of care consists of either endoscopic pneumatic dilation or surgical myotomy (laparoscopic Heller myotomy (LHM)). While a recent randomized trial suggested similar outcomes between these two modalities 2 , there is substantial evidence that LHM provides more durable symptomatic relief 3,4 , while also resulting in less iatrogenic gastroesophageal reflux (GER) post-intervention 5 . Peroral esophageal myotomy (POEM) is a novel operation for the treatment of achalasia that combines the advantages of a completely endoscopic (i.e.…”

Section: Introductionmentioning

confidence: 99%

Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes

et al. 2014

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Background The functional lumen imaging probe (FLIP) is a novel diagnostic tool that can be used to measure esophagogastric junction (EGJ) distensibility. In this study we performed intraoperative FLIP measurements during laparoscopic Heller myotomy (LHM) and peroral esophageal myotomy (POEM) for treatment of achalasia and evaluated the relationship between EGJ distensibility and postoperative symptoms. Methods Distensibility index (DI) (defined as the minimum cross-sectional area at the EGJ divided by distensive pressure) was measured with FLIP at two time points during LHM and POEM: 1) at baseline after induction of anesthesia, and 2) after operation completion. Results Measurements were performed in 20 patients undergoing LHM and 36 undergoing POEM. Both operations resulted in an increase in DI, although this increase was larger with POEM (7±3.1 vs. 5.1±3.4mm2/mmHg, p<.05). The two patients (both LHM) with the smallest increases in DI (1 and 1.6mm2/mmHg) both had persistent symptoms postoperatively and, overall, LHM patients with larger increases in DI had lower postoperative Eckardt scores. In the POEM group, there was no correlation between change in DI and symptoms; however, all POEM patients experienced an increase in DI of >3mm2/mmHg. When all patients were divided into thirds based on final DI, none in the lowest DI group (<6mm2/mmHg) had symptoms suggestive of reflux (i.e., GerdQ score >7), as compared with 20% in the middle third (6–9mm2/mmHg) and 36% in the highest third (>9mm2/mmHg). Patients within an “ideal” final DI range (4.5–8.5 mm2/mmHg) had optimal symptomatic outcomes (i.e. Eckardt≤1 and GerdQ≤7) in 88% of cases, compared with 47% in those with a final DI above or below that range (p<.05). Conclusions Intraoperative EGJ distensibility measurements with FLIP were predictive of postoperative symptomatic outcomes. These results provide initial evidence that FLIP has the potential to act as a useful calibration tool during operations for achalasia.

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“…9,11,12,24,26 This wide range of incidence seems to stem from various different definitions used to make a diagnosis of GERD. In a prospective study by Novais and Lemme, 24 they reported the incidence of gastroesophageal reflux (GER) of 31% using 24-hour pH tracing analysis to distinguish true GER patterns from other findings due to esophageal food fermentations. In the current study, there might be also little possibility that patients showing abnormal 24-hour pH monitoring findings due to food fermentation were erroneously included into GERD group.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of GERD is known to be associated with lower post-treatment LES pressure. 24,25 We therefore hypothesized that GERD after PD could have a prognostic role for RFS in patients who received PD for achalasia. In addition, we investigated how often GERD occurs in achalasia patients who undergo PD as an initial treatment, what factors are associated with the occurrence of GERD and how the clinical course of patients with post-PD GERD is.…”

Section: Discussionmentioning

confidence: 99%

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Ye¹,

Lee²,

Min³

et al. 2014

J Neurogastroenterol Motil

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Background/AimsThe occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esophageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilatation (PD) has a prognostic role and to investigate how the clinical course of GERD is. MethodsA 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. ResultsTwenty 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 patients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD. ConclusionsGERD 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.

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24‐h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy

Cited by 98 publications

References 38 publications

Current status of achalasia management: a review on diagnosis and treatment

Current status of achalasia management: a review on diagnosis and treatment

Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

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