Association between gastroesophageal reflux disease after pneumatic balloon dilatation and clinical course in patients with achalasia

Background/aims: The occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esoph-ageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilata-tion (PD) has a prognostic role and to investigate how the clinical course of GERD is.

Methods: A 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.

Results: Twenty 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 pa-tients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD.

Conclusions: GERD 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.