Disorders of Gut–Brain Interaction ( DGBI ) Symptoms and Response to Peroral Endoscopic Myotomy in Patients With Achalasia

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BACKGROUND AND AIMS: In patients with achalasia, we hypothesized that visceral hypersensitivity arising from concomitant disorders of gut-brain interaction (DGBI) may influence clinical presentation and response to therapy. Thus, in patients with achalasia, we assessed the clinical manifestations and response to peroral endoscopic myotomy (POEM) as well as the association with concomitant DGBI. METHODS: In 52 consecutive patients with achalasia who underwent POEM, we assessed gastrointestinal (esophageal and nonesophageal) and extraintestinal symptoms utilizing the Structured Assessment of Gastrointestinal Symptoms Instrument (SAGIS). In addition, the response to POEM was assessed with the Eckardt Score. RESULTS: Patients with type-III achalasia had a greater prevalence of psychological co-morbidities than type-I patients (77.78% vs. 21.43%, p = 0.01). Pre-POEM, patients with type-III achalasia had significantly more severe IBS-type symptoms of constipation and diarrhea when compared with type-I (p < 0.05). The POEM procedure reduced the mean Eckardt scores in patients with type-I (9.00 ± 2.18 vs. 1.00 ± 1.038, p < 0.0001), type-II (9.28 ± 2.234 vs. 1.59 ± 1.547, p < 0.0001), and type-III (7.67 ± 1.871 vs. 2.78 ± 2.635, p = 0.002). Based on the improvement of the Eckhardt score, 87% (45/52) responded to POEM. In type-III patients (5/9), inferior response was noted compared to type-I (14/14 patients, p = 0.01) and type-II (26/29, p = 0.04). Total SAGIS score decreased post-POEM in patients with type-I (baseline 18.29 ± 10.80 vs. post-POEM 8.643 ± 11.76, p = 0.001), and type-II (29.55 ± 18.53 vs. 12.69 ± 15.61, p < 0.0001), but not in type-III (baseline 34.22 ± 19.31 vs. post-POEM 23.22 ± 14.00, p = 0.18). CONCLUSION: Our findings suggest that altered gut-brain interactions play a role in the clinical manifestations of patients with achalasia, particularly in patients with type-III, and affect the response to therapy.

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