{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:00:10Z","timestamp":1787061610189,"version":"build-2736575974"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"09","funder":[{"name":"JGA Clinical Research Grants, Multicenter Research Grant of The Japanese Foundation for Research and Promotion of Endoscopy","award":["2021\u20131"],"award-info":[{"award-number":["2021\u20131"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background\u2002Gastroesophageal reflux disease (GERD) and reflux esophagitis remain problems after peroral endoscopic myotomy (POEM). This study aimed to elucidate the risk factors and long-term course of reflux esophagitis and symptomatic GERD after POEM.<\/jats:p>\n                  <jats:p>Methods\u2002This multicenter cohort study involved 14 high volume centers. Overall, 2905 patients with achalasia-related esophageal motility disorders treated with POEM were analyzed for reflux esophagitis, severe reflux esophagitis (Los Angeles classification C or D), and symptomatic GERD.<\/jats:p>\n                  <jats:p>Results\u2002Reflux esophagitis was diagnosed in 1886 patients (64.9\u200a%). Age \u2265\u200a65 years (risk ratio [RR] 0.85), male sex (RR 1.11), posterior myotomy (RR 1.12), esophageal myotomy &gt;\u200a10\u200acm (RR 1.12), and gastric myotomy &gt;\u200a2\u200acm (RR 1.17) were independently associated with reflux esophagitis. Severe reflux esophagitis was diagnosed in 219 patients (7.5\u200a%). Age \u2265\u200a65 years (RR 1.72), previous treatments (RR 2.21), Eckardt score \u2265\u200a7 (RR 0.68), sigmoid-type achalasia (RR 1.40), and esophageal myotomy &gt;\u200a10\u200acm (RR 1.59) were factors associated with severe reflux esophagitis. Proton pump inhibitors (PPIs) were more effective for reflux esophagitis at 5-year follow-up (P\u200a=\u200a0.03) than after 1 year (P\u200a=\u200a0.08). Symptomatic GERD was present in 458 patients (15.9\u200a%). Symptom duration \u2265\u200a10 years (RR 1.28), achalasia diagnosis (RR 0.68), integrated relaxation pressure \u2265\u200a26 (RR 0.60), and posterior myotomy (RR 0.80) were associated with symptomatic GERD. The incidence of symptomatic GERD was lower at 5-year follow-up compared with that after 1 year (P\u200a=\u200a0.04), particularly in PPI users (P\u200a&lt;\u200a0.001).<\/jats:p>\n                  <jats:p>Conclusions\u2002The incidence of severe reflux esophagitis was low after POEM, but excessive myotomy for older patients with previous treatments should be avoided. Early phase symptomatic GERD is non-acid reflux dependent and the natural course is favorable, basically supporting conservative treatment.<\/jats:p>","DOI":"10.1055\/a-1753-9801","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T18:45:14Z","timestamp":1645037114000},"page":"839-847","source":"Crossref","is-referenced-by-count":58,"title":["Risk factors and long-term course of gastroesophageal reflux disease after peroral endoscopic myotomy: A large-scale multicenter cohort study in Japan"],"prefix":"10.1055","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8435-3668","authenticated-orcid":false,"given":"Hironari","family":"Shiwaku","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7766-3724","authenticated-orcid":false,"given":"Hiroki","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan"},{"name":"Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4107-9264","authenticated-orcid":false,"given":"Yuto","family":"Shimamura","sequence":"additional","affiliation":[{"name":"Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Kobe University Hospital, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Shiota","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiaki","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Ominami","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-6347","authenticated-orcid":false,"given":"Hiroyuki","family":"Sakae","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2827-931X","authenticated-orcid":false,"given":"Yoshitaka","family":"Hata","sequence":"additional","affiliation":[{"name":"Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Tatsuta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Ikebuchi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine, Tottori, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Yokomichi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Yamanashi, Yamanashi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suguru","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhiro","family":"Inoue","sequence":"additional","affiliation":[{"name":"Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,2,16]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1055\/s-0029-1244080","article-title":"Peroral endoscopic myotomy (POEM) for esophageal achalasia","volume":"42","author":"H Inoue","year":"2010","journal-title":"Endoscopy"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1001\/jama.2019.8859","article-title":"Effect of peroral endoscopic myotomy vs 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