Recurrent Erosive Esophagitis After Surgical Treatment in Different Type of Achalasia

Background The aim of our study was to investigate the frequency of erosive esophagitis after surgery in different type of achalasia. Methods 120 patients from 18 to 84 y.o. with achalasia. Before peroral endoscopic myotomy (POEM) or laparoscopic myotomy (LM) the patients underwent high resolution esophageal manometry and endoscopy. All subjects were devided into 3 groups: group I (with achalasia type I—32 patients), group II (with type II—75 patients) and group III (with type III—13 patients). Before surgery 4 patients had erosive esophagitis LA-A and 2 patients—LA-D. Patients underwent upper endoscopy 6 months, one year and 2 years after surgery. All patients with erosive esophagitis (EE) after surgery were admitted proton pump inhibitors (PPI) for 3 months. Results In group I EE were evaluated in 5 persons (15.6%) 6 month after surgery. Recurrent EE was revealed in 3 pts (9.4%) despite PPI treatment. In group II EE was found in 10 patients (13.3%) 6 mo after surgery: 7 pts with LA-A and 3—LA-B. One year after surgery EE LA-A was found in 7 patients (9.3%). Two years after surgery EE LA-A was found in 4 patients (5.3%), one of them had LA-A across 2 years. EE was evaluated in one patient (7.7%) from group III six months after POEM. Recurrent EE was revealed in 1 patient. Conclusion The number of erosive esophagitis is higher in patients with type I and II achalasia. Patients who underwent some kind of treatment on achalasia need appropriate endoscopic follow-up. The recurrent erosive esophagitis requires long-term treatment of PPI.