P1359 - Prospective Evaluation of Symptom Correlation for Gastroesophageal Reflux Disease by Ambulatory Wireless pH Monitoring After Per-Oral Endoscopic Myotomy

Award: Presidential Poster Award

Award: Presidential Poster Award

John DeWitt, MD¹, Robert Siwiec, MD¹, William Kessler, MD¹, John Wo, MD¹, Thomas Nowak, MD¹, Toyia James-Stevenson, MD¹, Sarah Stainko, RN¹, Mohammad Al-Haddad, MD^2
1Indiana University Medical Center, Indianapolis, IN; ²Indiana University, Indianapolis, IN

Introduction: There are limited data correlating symptoms with reflux episodes during pH studies after POEM. The objective of this study is to evaluate the relationship of patient reported typical and atypical GERD symptoms with objective reflux episodes by ambulatory pH monitoring after POEM.

Methods: Consecutive patients between 2015 and 2019 who underwent POEM for esophageal motility disorders (EMDs) followed by post-POEM 48-hour ambulatory wireless pH testing off antisecretory therapy ≥6 months later were identified. Baseline high resolution impedance manometry (HRM), functional lumen imaging probe (FLIP) for esophagogastric junction distensibility index (EGJ-DI), and Eckardt scores (ES) were obtained followed ≥6 months after POEM with HRM, ES, FLIP, and pH testing. Symptoms during pH testing were recorded and symptom index (SI) and symptom association probability (SAP) were calculated. Symptom-reflux correlation was defined as SI ≥50% or SAP ≥ 95%. GERD was defined as positive or negative (equivocal or negative) by the Lyon classification. A multivariate analysis was performed to identify characteristics associated with a positive symptom-reflux correlation.

Results: 113 patients (55% male, mean 53±17 yrs.) were included. Mean baseline ES and IRP were 7.6±2.1 and 28.3±14.8 mmHg, respectively. Type 2 achalasia was present in 53.1% and previous EGJ therapy was performed in 54.9%. Post POEM GERD was present in 64.6% and was more frequent in patients with lower mean baseline IRP (26.2±13.6mmHg) compared to those without post-POEM GERD (32.0±16.3mmHg, p=0.044). Otherwise, baseline demographics, EMDs, previous therapy and results of POEM were similar between the two groups. At least one of seven symptoms was recorded in 68/113 (60.1%) pH studies (Table 1), most commonly heartburn in 31/68 (45.6%) and cough in 31/68 (45.6%). The frequency SI≥50% or SAP >95% for the seven reported symptoms ranged from 0-33.3% and 0-23.3% respectively. Among the 68 recording at least one symptom, only heartburn was more common in those with GERD (56.1% vs. 29.6%, p=0.047). Multivariate analysis of those with (n=13) and without (n=55) at least one symptom with SAP >95% failed to identify any independent predictive variable.

Discussion: In this series, post-POEM GERD was present in 64.6% and reported symptoms showed poor correlation with the abnormal acid exposure. Objective testing rather than patient reported symptoms are required to diagnose, treat and prevent potential complications from post–POEM GERD.



Disclosures:


John DeWitt, MD¹, Robert Siwiec, MD¹, William Kessler, MD¹, John Wo, MD¹, Thomas Nowak, MD¹, Toyia James-Stevenson, MD¹, Sarah Stainko, RN¹, Mohammad Al-Haddad, MD². P1359 - Prospective Evaluation of Symptom Correlation for Gastroesophageal Reflux Disease by Ambulatory Wireless pH Monitoring After Per-Oral Endoscopic Myotomy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.