Observational studyGut2021
Reflux symptoms and oesophageal acidification in treated achalasia patients are often not reflux related.
Observational study in Gut, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
17 citing papers in PubMed, 55 citations in OpenAlex.
- Peroral endoscopic myotomyWorld journal of gastroenterology · 2022Trial
- Long-term outcomes of peroral endoscopic myotomy (POEM): reflux esophagitis and complications including Barrett esophagus and peptic strictures.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2026Article
- High-Resolution Manometry in Treated Achalasia: Scoping Review and Novel Nomenclature.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Article
- Effect of sex on the outcomes of peroral endoscopic myotomy for the treatment of achalasia.World journal of gastroenterology · 2025Article
- No advantage of fundoplication in paraesophageal hernia repair: a retrospective multicenter study.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2025Article
- North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025Article
- Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis.Endoscopy international open · 2025Article
- Transoral incisionless fundoplication for patients with gastroesophageal reflux disease after peroral endoscopic myotomy: Prospective cohort.Endoscopy international open · 2025Article
- Prediction, prevention and management of gastroesophageal reflux after per-oral endoscopic myotomy: An update.World journal of gastroenterology · 2024Review
- Laparoscopic Heller myotomy with Toupet fundoplication: revisiting GERD in treated achalasia.Surgical endoscopy · 2024Article
- Modern Achalasia: Diagnosis, Classification, and Treatment.Journal of neurogastroenterology and motility · 2023Review
- Prevalence of Gastroesophageal Reflux Symptoms Post Sleeve Gastrectomy in Al-Qassim Region.Cureus · 2023Article
- Third-space endoscopy: the final frontier.Gastroenterology report · 2023Review
- Differences in upper esophageal sphincter function and clinical characteristics among the three subtypes of Japanese patients with esophageal achalasia.Esophagus : official journal of the Japan Esophageal Society · 2022Article
- One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy.Annals of medicine · 2021Article
- Advances and caveats in modern achalasia management.Therapeutic advances in chronic disease · 2021Review
- Esophageal hyposensitivity in achalasia cardia: Do we finally have an answer?United European gastroenterology journal · 2020Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveAfter 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.
designForty 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.
resultsTotal 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.
conclusionReflux 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.
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