Reflux Symptoms and Oesophageal Acidification in Treated Achalasia Patients Are Often Not Reflux Related

Overview

Journal Gut

Specialty Gastroenterology

Date 2020 May 23

PMID 32439713

Citations 10

Authors

Fraukje A Ponds

Jacobus M Oors

Andre J P M Smout

Albert J Bredenoord

Affiliations

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Abstract

Objective: After treatment, achalasia patients often develop reflux symptoms. Aim of this case-control study was to investigate mechanisms underlying reflux symptoms in treated achalasia patients by analysing oesophageal function, acidification patterns and symptom perception.

Design: Forty treated achalasia patients (mean age 52.9 years; 27 (68%) men) were included, 20 patients with reflux symptoms (RS+; Gastro-Oesophageal Reflux Disease Questionnaire (GORDQ) ≥8) and 20 without reflux symptoms (RS-: GORDQ <8). Patients underwent measurements of oesophagogastric junction distensibility, high-resolution manometry, timed barium oesophagogram, 24 hours pH-impedance monitoring off acid-suppression and oesophageal perception for acid perfusion and distension. Presence of oesophagitis was assessed endoscopically.

Results: Total acid exposure time during 24 hours pH-impedance was not significantly different between patients with (RS+) and without (RS-) reflux symptoms. In RS+ patients, acid fermentation was higher than in RS- patients (RS+: mean 6.6% (95% CI 2.96% to 10.2%) vs RS-: 1.8% (95% CI -0.45% to 4.1%, p=0.03) as well as acid reflux with delayed clearance (RS+: 6% (95% CI 0.94% to 11%) vs RS-: 3.4% (95% CI -0.34% to 7.18%), p=0.051). Reflux symptoms were not related to acid in both groups, reflected by a low Symptom Index. RS+ patients were highly hypersensitive to acid, with a much shorter time to heartburn perception (RS+: 4 (2-6) vs RS-:30 (14-30) min, p<0.001) and a much higher symptom intensity (RS+: 7 (4.8-9) vs RS-: 0.5 (0-4.5) Visual Analogue Scale, p<0.001) during acid perfusion. They also had a lower threshold for mechanical stimulation.

Conclusion: Reflux symptoms in treated achalasia are rarely caused by gastro-oesophageal reflux and most instances of oesophageal acidification are not reflux related. Instead, achalasia patients with post-treatment reflux symptoms demonstrate oesophageal hypersensitivity to chemical and mechanical stimuli, which may determine symptom generation.

Citing Articles

Focal Distal Esophageal Dilation (Blown-Out Myotomy) After Achalasia Treatment: Prevalence and Associated Symptoms.

Kuipers T, Ponds F, Fockens P, Bastiaansen B, Pandolfino J, Bredenoord A Am J Gastroenterol. 2024; 119(10):1983-1989.

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Prediction, prevention and management of gastroesophageal reflux after per-oral endoscopic myotomy: An update.

Nabi Z, Inavolu P, Duvvuru N World J Gastroenterol. 2024; 30(9):1096-1107.

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Laparoscopic Heller myotomy with Toupet fundoplication: revisiting GERD in treated achalasia.

Blaustein M, Sillcox R, Wright A, Tatum R, Yates R, Bryant M Surg Endosc. 2023; 38(3):1283-1288.

PMID: 38102398 DOI: 10.1007/s00464-023-10643-4.

Modern Achalasia: Diagnosis, Classification, and Treatment.

Pesce M, Pagliaro M, Sarnelli G, Sweis R J Neurogastroenterol Motil. 2023; 29(4):419-427.

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Prevalence of Gastroesophageal Reflux Symptoms Post Sleeve Gastrectomy in Al-Qassim Region.

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PMID: 37746463 PMC: 10517694. DOI: 10.7759/cureus.44040.

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