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Is POEM a good answer in the long-term?

Henriette Heinrich 1

Affiliations

1 Stadtspital Triemli, Zürich, Switzerland

Summary

AI Generated

The speaker reported that while poem shows 90-98% short-term success for type 3 achalasia and 75-93% success at 1-2 years for distal oesophageal spasm and jackhammer oesophagus, long-term data remain limited and patient selection is critical to outcomes.

The speaker stated ten-year success rates for achalasia overall are 74%, but numbers specifically for type 3 achalasia are too low to draw valid conclusions about long-term efficacy
Patients on opioids had significantly higher failure rates after poem in a propensity-matched study of 120 patients, with a dose-dependent effect where higher opioid doses predicted worse outcomes
The speaker emphasized that careful patient selection is essential, requiring exclusion of GERD, oesophageal hypersensitivity, and opioid-induced spasm, with evaluation over 6-12 months and failure of other treatments before considering poem for spastic disorders
Tailoring myotomy length based on manometry findings and considering whether to spare the lower oesophageal sphincter in distal oesophageal spasm and jackhammer may reduce reflux without compromising outcomes, though data are limited to small studies
The speaker recommends multidisciplinary discussion with motility specialists and cautions that poem may not fully resolve symptoms if functional components are present, particularly in spastic disorders beyond type 3 achalasia

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Abstract

Event

UEG Week Berlin 2025

Topics

Oesophagus Primary Care

Session

Spastic oesophagus: Is it curable?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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A clinician's overview of microscopic colitis

Yamile Zabana

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Wojciech Blogowski

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Sara Nikolić

Panel discussion: Metabolic and vascular disorders of the liver

VONOPRAZAN VERSUS LANSOPRAZOLE FOR HEALING EROSIVE ESOPHAGITIS IN PATIENTS WITH SYSTEMIC SCLEROSIS (HEAL-SSC): A PRELIMINARY REPORT OF RANDOMIZED PLACEBO-CONTROLLED TRIAL

Witsarut Manasirisuk

INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Albert J. Bredenoord

UEG Presentation

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A clinician's overview of microscopic colitis

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A clinician's overview of microscopic colitis

Yamile Zabana 1

Affiliations

1 Hospital Universitari Mútua Terrassa, Terrassa, Spain

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Primary Care

Session

Easily overlooked cases of chronic diarrhoea

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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A clinician's overview of microscopic colitis

Yamile Zabana

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Wojciech Blogowski

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Sara Nikolić

Panel discussion: Metabolic and vascular disorders of the liver

VONOPRAZAN VERSUS LANSOPRAZOLE FOR HEALING EROSIVE ESOPHAGITIS IN PATIENTS WITH SYSTEMIC SCLEROSIS (HEAL-SSC): A PRELIMINARY REPORT OF RANDOMIZED PLACEBO-CONTROLLED TRIAL

Witsarut Manasirisuk

INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Albert J. Bredenoord

UEG Presentation

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Summary: From risk to recover - A postgraduate dive into gastric cancer care

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Summary: From risk to recover - A postgraduate dive into gastric cancer care

Wojciech Blogowski 1

Affiliations

1 RUSH University Medical Center, Chicago, IL, United States of America

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Endoscopy Stomach & H. Pylori Surgery

Session

From risk to recovery: A postgraduate dive into gastric cancer care

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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A clinician's overview of microscopic colitis

Yamile Zabana

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Sara Nikolić

Panel discussion: Metabolic and vascular disorders of the liver

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Witsarut Manasirisuk

INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Albert J. Bredenoord

UEG Presentation

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Summary: UEG Journal Session

Sara Nikolić 1

Affiliations

1 University Medical Center Maribor, Maribor, Slovenia

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses Pancreas Radiology & Imaging

Session

Hot topics in European gastroenterology

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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A clinician's overview of microscopic colitis

Yamile Zabana

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Sara Nikolić

Panel discussion: Metabolic and vascular disorders of the liver

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Witsarut Manasirisuk

INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Albert J. Bredenoord

UEG Presentation

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Panel discussion: Metabolic and vascular disorders of the liver

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Panel discussion: Metabolic and vascular disorders of the liver

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Hepatobiliary

Session

Metabolic and vascular disorders of the liver

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

A clinician's overview of microscopic colitis

Yamile Zabana

Summary: From risk to recover - A postgraduate dive into gastric cancer care

Wojciech Blogowski

Summary: UEG Journal Session

Sara Nikolić

Panel discussion: Metabolic and vascular disorders of the liver

VONOPRAZAN VERSUS LANSOPRAZOLE FOR HEALING EROSIVE ESOPHAGITIS IN PATIENTS WITH SYSTEMIC SCLEROSIS (HEAL-SSC): A PRELIMINARY REPORT OF RANDOMIZED PLACEBO-CONTROLLED TRIAL

Witsarut Manasirisuk

INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Albert J. Bredenoord

UEG Poster

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VONOPRAZAN VERSUS LANSOPRAZOLE FOR HEALING EROSIVE ESOPHAGITIS IN PATIENTS WITH SYSTEMIC SCLEROSIS (HEAL-SSC): A PRELIMINARY REPORT OF RANDOMIZED PLACEBO-CONTROLLED TRIAL

Rachaporn Kongbumrung 1, Tanita Suttichaimongkol 2, Wattana Sukeepaisarnjaroen 3, Pisaln Mairiang 1, Chingching Foochareon 1, apichat sangchan 1, Kookwan Sawadpanich 1, Chitchai Rattananukrom 1, Witsarut Manasirisuk 1

Affiliations

1 KhonKaen University, KhonKaen, Thailand

2 Srinagarind Hospital, Khon Kaen, Thailand

3 Faculty of Medicine, Khon Kaen, Thailand

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Abstract

Introduction

Systemic sclerosis (SSc) is a rare and complex autoimmune disorder characterized by fibrosis of the skin and internal organs, as well as vasculopathy. The disease can be classified into two main subtypes: diffuse and limited. The diffuse subtype is more frequently associated with significant internal organ fibrosis. In the Asia-Pacific region, Thailand has the highest prevalence of systemic sclerosis, with an incidence of 24.4 per 100,000 population. Gastrointestinal involvement occurs in over 90% of patients with SScwith esophageal involvement being particularly common. Among these, gastroesophageal reflux disease (GERD) is present in approximately 80% of SSc patients. Erosive esophagitis (EE), a severe form of GERD characterized by the erosion of esophageal mucosa, is observed in about 80% of GERD cases. Its severity is classified according to the Los Angeles classification (grades A to D), with 30% of cases classified as severe (Los Angeles grades C and D). Proton pump inhibitors (PPIs) are currently the standard treatment for GERD and EE in SSc patients. However, fewer than 50% of patients demonstrate adequate response to PPIs therapy, highlighting the need for alternative treatments. Vonoprazan, a novel potassium-competitive acid blocker (PCAB), has emerged as a potent and longer-acting alternative to traditional PPIs. It has shown superior efficacy in treating severe erosive esophagitis in the general population. Previous cohort studies have demonstrated promising results with vonoprazan in improving symptoms and healing rates in SSc patients with refractory GERD up to 60% in refractory GERD; However, randomized controlled trials evaluating its efficacy in this population remain limited. This study aims to conduct a randomized controlled trial comparing the efficacy of vonoprazan and PPIs in treating erosive esophagitis in SSc patients.

Aims & Methods

The aim was to compare the efficacy of vonoprazan and lansoprazole in healing erosive esophagitis in patients with systemic sclerosis.
A randomized placebo-controlled trial was conducted in patients with systemic sclerosis (SSc) and refractory GERD who had erosive esophagitis confirmed by endoscopy. Participants were recruited from the systemic sclerosis clinic at Srinagarind Hospital, Khon Kaen University, from June 2024 to March 2025. Patients were randomized to receive either vonoprazan 20 mg once daily or lansoprazole 30 mg once daily for 8 weeks. The primary outcome was the percentage of healing at 8 weeks. Secondary outcomes included improvement in gastro-esophageal reflux disease (GERD) symptoms, as assessed by the Frequency Scale for the Symptoms of GERD (FSSG), GERD Questionnaire (GerdQ), and visual analogue scales (VAS) for heartburn and regurgitation.

Results

A total of 48 patients were enrolled in the study. The healing rates for vonoprazan and lansoprazole were 73.9% and 39.1%, respectively, resulting in an absolute risk reduction of 0.348 (95% CI: 0.081–0.614; p-value: 0.017). Subgroup analysis of patients with severe erosive esophagitis, defined as Los Angeles (LA) grades C-D, demonstrated that vonoprazan was superior to lansoprazole (75% vs. 33.3%; absolute risk reduction: 0.52; 95% CI: 0.167–0.873; p-value: 0.008). No significant difference was observed between the two treatments in patients with LA grades A-B.

Conclusion

Preliminary data suggests that vonoprazan was superior to lansoprazole in the healing of erosive esophagitis in systemic sclerosis patients, with this benefit being particularly evident in cases of severe erosive esophagitis (LA grades C-D).

References

1. Volkmann ER, Andréasson K, Smith V. Systemic sclerosis. Lancet. 2023 Jan 28;401(10373):304–18.
2. Foocharoen C, Ngamjarus C, Pattanittum P, Suwannaroj S, Pongkulkiat P, Onchan T, et al. Incidence and prevalence of systemic sclerosis in Thailand in year 2017-2020: a database from the Ministry of Public Health. Clin Rheumatol. 2023 Jul;42(7):1767–74.
3. Emmanuel A. Current management of the gastrointestinal complications of systemic sclerosis. Nat Rev Gastroenterol Hepatol. 2016 Aug;13(8):461–72.
4. McMahan ZH. Gastrointestinal involvement in systemic sclerosis: an update. Curr Opin Rheumatol. 2019 Nov;31(6):561–8.
5. Roth E, Bruni C, Petelytska L, Becker MO, Dobrota R, Jordan S, et al. Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort. Rheumatology. 2025 Jan 8;keaf016.
6. Denaxas K, Ladas SD, Karamanolis GP. Evaluation and management of esophageal manifestations in systemic sclerosis. Ann Gastroenterol. 2018;31(2):165–70.
7. Chunlertrith K, Noiprasit A, Foocharoen C, Mairiang P, Sukeepaisarnjaroen W, Sangchan A, et al. GERD questionnaire for diagnosis of gastroesophageal reflux disease in systemic sclerosis. Clin Exp Rheumatol. 2014;32(6 Suppl 86):S-98-102.

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

GERD (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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A clinician's overview of microscopic colitis

Yamile Zabana

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Wojciech Blogowski

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Sara Nikolić

Panel discussion: Metabolic and vascular disorders of the liver

VONOPRAZAN VERSUS LANSOPRAZOLE FOR HEALING EROSIVE ESOPHAGITIS IN PATIENTS WITH SYSTEMIC SCLEROSIS (HEAL-SSC): A PRELIMINARY REPORT OF RANDOMIZED PLACEBO-CONTROLLED TRIAL

Witsarut Manasirisuk

INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Albert J. Bredenoord

UEG Presentation

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INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Alberto Barchi 1, Edoardo Vespa 1, Francesco Vito Mandarino 1, Antonio Ventimiglia 1, Marina Girelli 1, Micaela Marchisotta 1, Giuseppe Dell'Anna 1, Milli Gupta 2, Francesca Rusconi 3, Vito Annese 4, Edoardo Vincenzo Savarino 5, Silvio Danese 1, Sandro Passaretti 1, Albert J. Bredenoord 6

Affiliations

1 IRCCS Ospedale San Raffaele, Milan, Italy

2 University of Calgary, Calgary, AB, Canada

3 TriNetX Europe NV, Sint-Martens-Latem, Belgium

4 IRCCS Policlinico San Donato, Milan, Italy

5 University of Padua, Division of Gastroenterology, Padua, Italy

6 Amsterdam UMC, Amsterdam, Netherlands

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Abstract

Introduction

Achalasia is a chronic idiopathic condition characterized by the absence of esophageal peristalsis and reduced relaxation of the lower esophageal sphincter, causing progressive dysphagia and weight loss. EA has been investigated as a potential risk factor for esophageal cancer (EC); squamous cancer due to chronic inflammation related to stasis due to poor esophageal emptying and adenocarcinoma due to uncontrolled gastroesophageal reflux after treatment [1]. Longstanding disease, repeated treatment, age and male sex have been addressed as the most relevant risk factors [2], but no clear effect size estimation from large sample cohorts has been provided so far [3].

Aims & Methods

We conducted a retrospective cohort study, accessing the global federated health research network “TriNetX”, that provides access to electronic medical records from approximately a hundred million patients across large healthcare organizations (HCOs). The analysis was performed on March 25^th 2025 on the Global collaborative network on achalasia patients, based on the ICD-10 code (K22.0), from January 1^st 2000 until January 31^st 2024. We first investigated the incidence rate (cases/1000 persons-year) and cumulative prevalence of EC in an achalasia cohort in a span of 25 years. Then we inferred the risk of EC, by comparing the achalasia cohort with control population, using propensity score nearest neighbor greedy matching, for relevant covariates. Kaplan-Meyer (KM) analysis with censoring, Hazard Ratios (HRs) and Risk Difference (RD) estimation for EC risk were calculated. Log Rank test was used to compare Kaplan-Meyer curves. Further sub-group analysis was implemented between two population of achalasia patients, treated (with endoscopic/surgical myotomy or pneumatic dilation) and treatment-naïve.

Results

Among a cohort of 68,115 achalasia patients in a span of 25 years of follow-up, the cumulative prevalence of EC was 0.83% (increasing from 0.23% to 0.72% between 2000-2005 and 2020-2025) with an overall incidence rate of 0.87 cases/1000persons-year (increasing from 0.52 to 1.43 between 2000-2005 and 2020-2025). After 1:1 propensity score matching, 63,686 EA patients were compared with 63,686 control subjects (mean age 58.3±19.2 years, M 45%, previous history of malignant GI neoplasm 5.8%, alcohol users 2.1%; PPI use 35%; all p>0.05). The total number of EC occurrences were 517 (risk 0.008) in EA group compared to 86 (risk 0.001) in the control group, resulting in a RD of 0.007 (0.006-0.008, 95%CI, p<0.0001) and an HR of 6.7 (5.3-8.4, 95%CI, p<0.00001). At KM analysis, survival probability was 97.5% in achalasia group compared to 99.6% in controls in more than 20 years of follow-up (log rank test p<0.00001). In subgroup analysis of 4,166 treated vs untreated achalasia patients, the risk of EC after treatment (26 total cases) was considerably higher in the first group with a RD of 0.003 (0.001-0.006 95%CI, p=0.037) and a HR 2.46 (1.26-4.80, 95%CI, p<0.009) in a mean follow-up of 1,031.8 days.

Conclusion

The results from this large population analysis from multicenter global database with 20 years of follow-up of achalasia confirm the higher risk of EC in long-standing achalasia compared with healthy subjects. Furthermore, an in-depth analysis apparently indicated that the risk of EC is higher after treatment of achalasia, suggesting the need of prolonging the endoscopic surveillance, particularly in patients after treatment.

References

1. Zaninotto G, Rizzetto C, Zambon P, Guzzinati S, Finotti E, Costantini M. Long-term outcome and risk of oesophageal cancer after surgery for achalasia. Br J Surg. 2008 Dec;95(12):1488-94. doi: 10.1002/bjs.6413. PMID: 18991316.
2. Oude Nijhuis RAB, Zaninotto G, Roman S, Boeckxstaens GE, Fockens P, Langendam MW, Plumb AA, Smout A, Targarona EM, Trukhmanov AS, Weusten B, Bredenoord AJ. European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations. United European Gastroenterol J. 2020 Feb;8(1):13-33. doi: 10.1177/2050640620903213. PMID: 32213062; PMCID: PMC7005998.
3. Ponds FA, Moonen A, Smout AJPM, Rohof WOA, Tack J, van Gool S, Bisschops R, Bredenoord AJ, Boeckxstaens GE. Screening for dysplasia with Lugol chromoendoscopy in longstanding idiopathic achalasia. Am J Gastroenterol. 2018 Jun;113(6):855-862. doi: 10.1038/s41395-018-0064-1. PMID: 29748564.

Disclosure

E.V. received speaker and/or consulting fees from Sanofi/Regeneron, Falk Pharma, Apollo Therapeutics, and Aurora Biofarma. EVS received consulting fees from Dr Falk Pharma and Reckitt Benckiser; research support from Medtronic and Diversatek Healthcare. AJB received research funding from BMS, Sanofi/Regeneron, SST, and Dr. Falk Pharma and received speaker and/or consulting fees from Uniquity, Laborie, Medtronic, BMS, Dr. Falk Pharma, Calypso Biotech, Eupraxia, Aqilion, Alimentiv, Sanofi/Regeneron, Uniquity, Reckitt, AlfaSigma and AstraZeneca. All other authors did not have any disclosures.

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Submission format

Abstract

Session

From prediction to detection in upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

A clinician's overview of microscopic colitis

Yamile Zabana

Summary: From risk to recover - A postgraduate dive into gastric cancer care

Wojciech Blogowski

Summary: UEG Journal Session

Sara Nikolić

Panel discussion: Metabolic and vascular disorders of the liver

VONOPRAZAN VERSUS LANSOPRAZOLE FOR HEALING EROSIVE ESOPHAGITIS IN PATIENTS WITH SYSTEMIC SCLEROSIS (HEAL-SSC): A PRELIMINARY REPORT OF RANDOMIZED PLACEBO-CONTROLLED TRIAL

Witsarut Manasirisuk

INCIDENCE, PREVALENCE AND OVERALL RISK OF ESOPHAGEAL CANCER IN ACHALASIA: A PROPENSITY-MATCHED POPULATION-BASED STUDY FROM A LARGE MULTICENTER DATABASE

Albert J. Bredenoord

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