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Achalasia and gastroparesis: Coexisting entities or consequence of therapy?
No association has been reported between achalasia and gastroparesis despite similar pathophysiologic mechanisms and therapeutic options. A literature review shows only two reports of patients with both disorders for whom esophageal peroral endoscopic myotomy (POEM) and gastric (G-POEM) were performed. We have observed a number of patients with both conditions and question the possibility that their coexistence is not rare. We further propose a novel explanation for the increased incidence of gastroesophageal reflux disease (GERD) following treatment of achalasia.
Seven patients underwent POEM for achalasia with a resolution of dysphagia. A few months later, the patients developed symptoms of gastroparesis and new-onset GERD. G-POEM was performed successfully, and all patients had resolution or significant improvement in their GERD symptoms. Most patients were off proton pump inhibitors (PPIs) or using PPIs as needed only.
Concurrent or consecutive achalasia and gastroparesis raise the question of an alternative explanation for symptomatic GERD after POEM if the conditions either coexist or gastroparesis follow as a consequence of POEM by an unknown mechanism. In our patients, treatment of gastroparesis by G-POEM resolved reflux symptoms. Whether patients with achalasia have underlying, subclinical delayed gastric emptying is an important topic that warrants study and raises the question of performing gastric emptying study on all patients with achalasia before or after POEM.
Received: 31 October 2020
Accepted: 03 February 2021
16 July 2021 (online)
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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