Manual Review of pH Tracings Helpful in Defining GERD After POEM

Manual Review of pH Tracings Helpful in Defining GERD After POEM

Prateek Sharma, MD, FASGE, reviewing Singh AP, et al. Gastrointest Endosc 2023 Aug 18.

The prevalence of GERD after peroral endoscopic myotomy (POEM) ranges from 13% to 58%. This variation is due to a lack of precise definitions and measurement methods for reflux, specifically if pH monitoring results are used to define GERD. The aim of this study was to identify risk factors and determine the incidence of „true acid reflux“ in patients with achalasia after POEM by manually analyzing pH tracings to characterize different acidification patterns.

In this prospective cohort study of 54 patients with achalasia who underwent POEM, true acid reflux was defined as acid reflux with normal and delayed clearance; other patterns were identified by manual analysis of pH tracings and categorized as „non-reflux acidification patterns.“ 

Results revealed that 29.6% of patients exhibited true acid reflux based on manual readings, compared with 64.8% identified through automated analysis. The study also found that increasing age (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.02-1.27; P=.04) and a higher preprocedural integrated relaxation pressure (OR, 1.13; 95% CI, 1.04-1.30; P=.02) were significantly associated with true acid reflux in patients after POEM. Additionally, after POEM, there was a substantial improvement in the mean Eckardt score, which decreased from 6.7 to 1.6 (P<.05).

Prateek Sharma, MD, FASGE


A manual review of pH tracings should be conducted in patients after POEM when GERD is suspected. This will help in defining those patients with true acid reflux.



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Singh AP, Singla N, Budhwani E, et al. Defining the “true acid reflux” after per-oral endoscopic myotomy for achalasia: a prospective cohort study. Gastrointest Endosc 2023 Aug 18. (Epub ahead of print) (

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