{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:34:43Z","timestamp":1793230483947,"version":"4.5.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":40,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia, but short-term follow-up studies suggest an increased risk of gastroesophageal reflux after treatment. The aim of this study was to evaluate the risk of reflux esophagitis and the long-term complications in achalasia patients more than 5 years after POEM. This prospective cohort study included achalasia patients who underwent POEM between August 2011 and December 2019 and were scheduled for follow-up upper gastrointestinal endoscopy at least five years after treatment. Multivariate regression was used to assess predictive factors for reflux esophagitis after POEM. In total 161 achalasia patients were included of whom 153 completed questionnaires. Median age at follow-up was 56\u00a0years and 49.7% were female. Reflux esophagitis was diagnosed in 67 patients (41.6%, 95%-CI 34.0%\u201349.2%), with 22 of these cases classified as severe (grade C\/D, 32.8%). Prior laparoscopic Heller myotomy (OR 0.44, 95%-CI 0.20\u20130.98) and retreatment with PD (OR 0.36, 95%-CI 0.17\u20130.75) were associated with lower observed rates of reflux esophagitis. Factors associated with severe reflux esophagitis (grade C\/D) included BMI (OR 1.13, 95%-CI 1.04\u20131.23) and PD after POEM (OR 0.12, 95%-CI 0.02\u20130.93). Barrett esophagus was observed in five patients (3.1%). Peptic strictures were seen in three patients (1.9%) necessitating dilation and no cases of esophageal adenocarcinoma were identified. Reflux esophagitis remains a common long-term finding in achalasia patients more than 5 years after POEM and is classified as severe in nearly one-third of these cases.<\/jats:p>","DOI":"10.1093\/dote\/doag086","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:49:31Z","timestamp":1786016971000},"source":"Crossref","is-referenced-by-count":2,"title":["Long-term outcomes of peroral endoscopic myotomy (POEM): reflux esophagitis and complications including Barrett esophagus and peptic strictures"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3721-8279","authenticated-orcid":false,"given":"Elise M","family":"Wessels","sequence":"first","affiliation":[{"name":"Department of Gastroenterology & Hepatology, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology, Endocrinology & Metabolism, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwen M C","family":"Masclee","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology & Hepatology, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology, Endocrinology & Metabolism, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara A J","family":"Bastiaansen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology & Hepatology, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology, Endocrinology & Metabolism, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Fockens","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology & Hepatology, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology, Endocrinology & Metabolism, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Department of Gastroenterology, Waikato Hospital , Hamilton ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert J","family":"Bredenoord","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology & Hepatology, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology, Endocrinology & Metabolism, University Medical Centers Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081118500316700_ref1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0140-6736(13)60651-0","article-title":"Achalasia","volume":"383","author":"Boeckxstaens","year":"2014","journal-title":"Lancet"},{"key":"2026081118500316700_ref2","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S2468-1253(25)00012-3","article-title":"Per-oral endoscopic myotomy versus laparoscopic Heller's myotomy plus dor fundoplication in patients with idiopathic achalasia: 5-year follow-up of a multicentre, randomised, open-label, non-inferiority trial","volume":"10","author":"Hugova","year":"2025","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026081118500316700_ref3","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/S2468-1253(22)00300-4","article-title":"Peroral endoscopic myotomy versus pneumatic dilation in treatment-naive patients with achalasia: 5-year follow-up of a randomised controlled trial","volume":"7","author":"Kuipers","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026081118500316700_ref4","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":"Inoue","year":"2010","journal-title":"Endoscopy."},{"key":"2026081118500316700_ref5","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1080\/17474124.2023.2286279","article-title":"An overview of the efficacy, safety, and predictors of achalasia treatments","volume":"17","author":"Wessels","year":"2023","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2026081118500316700_ref6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1136\/gutjnl-2020-320772","article-title":"Reflux symptoms and oesophageal acidification in treated achalasia patients are often not reflux related","volume":"70","author":"Ponds","year":"2021","journal-title":"Gut."},{"key":"2026081118500316700_ref7","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.gie.2017.10.022","article-title":"GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis","volume":"87","author":"Repici","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"2026081118500316700_ref8","doi-asserted-by":"crossref","first-page":"e14794","DOI":"10.1111\/nmo.14794","article-title":"Incidence and risk factors of reflux esophagitis after peroral endoscopic myotomy","volume":"36","author":"Wessels","year":"2024","journal-title":"Neurogastroenterol Motil"},{"key":"2026081118500316700_ref9","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1001\/jama.2020.21360","article-title":"Gastroesophageal reflux disease: a review","volume":"324","author":"Maret-Ouda","year":"2020","journal-title":"JAMA."},{"key":"2026081118500316700_ref10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1053\/gast.1996.v111.pm8698230","article-title":"The endoscopic assessment of esophagitis: a progress report on observer agreement","volume":"111","author":"Armstrong","year":"1996","journal-title":"Gastroenterology."},{"key":"2026081118500316700_ref11","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1053\/j.gastro.2006.08.032","article-title":"The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria","volume":"131","author":"Sharma","year":"2006","journal-title":"Gastroenterology."},{"key":"2026081118500316700_ref12","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/nmo.12477","article-title":"The Chicago classification of esophageal motility disorders, 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