<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-6483</journal-id>
<journal-title><![CDATA[Endoscopia]]></journal-title>
<abbrev-journal-title><![CDATA[Endoscopia]]></abbrev-journal-title>
<issn>2444-6483</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Endoscopia Gastrointestinal A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-64832019000600153</article-id>
<article-id pub-id-type="doi">10.24875/end.m19000075</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[La exposición ácida anormal no predice el daño esofágico en pacientes postPOEM por el diagnóstivo de Acalasia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pintor-Belmontes]]></surname>
<given-names><![CDATA[Julio Cesar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández-Mondragón]]></surname>
<given-names><![CDATA[Óscar Víctor]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Centro Médico Nacional Siglo XXI Hospital de Especialidades &#8220;Dr. Bernardo Sepúlveda Gutiérrez&#8221;]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>31</volume>
<fpage>153</fpage>
<lpage>158</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-64832019000600153&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-64832019000600153&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-64832019000600153&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La eficacia de la miotomía peroral endoscópica (POEM) para el alivio de disfagia es mayor al 90%, siendo comparable con la miotomía de Heller, inclusive es una alternativa terapéutica en pacientes que presentan recurrencia o persistencia de la sintomatología posterior a una miotomía de Heller. Aun se esta evaluando el control de la disfagia a largo plazo la progresión de la dilatación esofágica y el reflujo posterior al procedimiento. El tratamiento de la acalasia por miotomía endoscopica peroral esta asociado con una incidencia mayor de enfermedad por reflujo gastroesofágico (ERGE), comparado con terapias alternativas como la miotomía de Heller o la dilatación neumática.  Objetivo: Determinar la exposición ácida anormal en los pacientes sometidos a POEM por diagnóstico de acalasia y evaluar su asociación con los grados de esofagitis de acuerdo con la clasificación de Los Angeles. Objetivos secundarios: determinar la asociación de la exposición anormal ácida postPOEM con el tipo de acalasia y la longitud de la miotomía.  Material y métodos: Se incluyó a todos pacientes sometidos a POEM por diagnóstico de acalasia en el servicio en el periodo de Enero del año 2015 a Diciembre de 2018. Se excluyeron pacientes postoperados de miotomía Heller o cirugía de hiato.  Resultados: Se obtuvo un total de 45 pacientes sometidos a POEM por diagnóstico de acalasia, dentro del periodo de Enero 2015 a Diciembre del 2018. No se encuentran diferencias entre la exposición ácida anormal y la edad (p 0.96), sexo (p 0.29), tipo de acalasia (p 0.48), longitud de la miotomía (p 0.51) o grado de esofagitis de acuerdo con la escala de Los Angeles (p 0.22). No hay diferencia entre los pacientes que presentaban algún grado endoscópico de esofagitis de acuerdo con la clasificación de Los Angeles con respecto al tipo de acalasia (p 0.80), la longitud de la miotomía (p 0.99), el porcentaje de exposición ácida en 24 hr (p 0.28). Se observa una tendencia (p 0.08) a la asociación entre la presencia de esofagitis y la exposición ácida anormal.  Conclusiones: La técnica POEM ha ganado aceptación a nivel mundial debido a la eficacia para tratar la disfagia; comparable en algunos casos a la miotomía de Heller. En este estudio realizado en nuestra población o en otros con muestras mas representativas, no se han encontrado factores predictores para el desarrollo de reflujo gastroesofágico posterior a POEM en pacientes con acalasia. Esto nos lleva a buscar alternativas endoscópicas en el tratamiento de ERGE para solidificar la eficacia del POEM para el tratamiento de la acalasia.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: The efficacy of peroral endoscopic myotomy (POEM) for the relief of dysphagia is greater than 90%, being comparable with Heller&#8217;s myotomy, it is even a therapeutic alternative in patients with recurrence or persistence of symptoms after Heller&#8217;s myotomy. The control of long-term dysphagia, progression of esophageal dilation and reflux after the procedure is still being evaluated. The treatment of achalasia by peroral endoscopic myotomy is associated with a higher incidence of gastroesophageal reflux disease (GERD), compared to alternative therapies such as Heller myotomy or pneumatic dilatation.  Objective: To determine the abnormal acid exposure in patients undergoing POEM due to diagnosis of achalasia and to evaluate its association with the degrees of esophagitis according to Los Angeles classification. Secondary objectives: to determine the association of abnormal acid exposure postPOEM with the type of achalasia and the length of the myotomy.  Materials and methods: All patients undergoing POEM for diagnosis of achalasia in the period from January of the year 2015 to December of 2018 were included. We excluded patients with a previous Heller&#8217;s myotomy or hiatus surgery.  Results: A total of 45 patients were included. There were no differences between abnormal acid exposure and age (p 0.96), sex (p 0.29), type of achalasia (p 0.48), length of myotomy (p 0.51) or degree of esophagitis according to Los Angeles scale (p 0.22). There were no differences between the patients who presented some endoscopic degree of esophagitis according to Los Angeles classification and the type of achalasia (p 0.80), the length of the myotomy (p 0.99), the percentage of acid exposure in 24 hours (p 0.28). There is a tendency (p 0.08) to the association between the presence of esophagitis and the abnormal acid exposure.  Conclusions: The POEM technique has gained worldwide acceptance due to the efficacy to treat dysphagia; comparable in some cases to Heller&#8217;s myotomy. In this study developed in our population and in others with more representative samples, predictive factors for the development of gastroesophageal reflux after POEM in patients with achalasia have not been found. This leads us to look for endoscopic alternatives in the treatment of GERD to solidify the efficacy of POEM for the treatment of achalasia.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Acalasia]]></kwd>
<kwd lng="es"><![CDATA[Miotomía peroral endoscópica]]></kwd>
<kwd lng="es"><![CDATA[Enfermedad por reflujo gastroesofágico.Esofagitis]]></kwd>
<kwd lng="en"><![CDATA[Achalasia]]></kwd>
<kwd lng="en"><![CDATA[Peroral endoscopic myotomy]]></kwd>
<kwd lng="en"><![CDATA[Gastroesophageal reflux disease]]></kwd>
<kwd lng="en"><![CDATA[Esophagitis]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pandolfino]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Gawron]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Achalasia]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2015</year>
<volume>313</volume>
<numero>18</numero>
<issue>18</issue>
<page-range>1841-52</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Boeckxstaens]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Zaninotto]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Richter]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Achalasia]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2014</year>
<volume>383</volume>
<page-range>83-93</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vaezi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pandolfino]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Vela]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[ACG Clinical Guideline:Diagnosis and Management of Achalasia]]></article-title>
<source><![CDATA[Am J Gastroenterol]]></source>
<year>2013</year>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kahrilas]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Bredenoord]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Fox]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Chicago Classification of esophageal motility disorders, v3.0]]></article-title>
<source><![CDATA[Neurogastroenterol Motil]]></source>
<year>2015</year>
<volume>27</volume>
<page-range>160-74</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Akintoye]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Obaitan]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Peroral endoscopic myotomy:a meta-analysis]]></article-title>
<source><![CDATA[Endoscopy]]></source>
<year>2016</year>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zaninotto]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Bennett]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Boeckxstaens]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The 2018 ISDE achalasia guidelines]]></article-title>
<source><![CDATA[Diseases of the Esophagus]]></source>
<year>2018</year>
<volume>31</volume>
<page-range>1-29</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Talukdar]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Inoue]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Nageshwar]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Efficacy of peroral endoscoic myotomy (POEM) in the treatment of achalasia:a systematic review and meta-analysis]]></article-title>
<source><![CDATA[Surg Endosc]]></source>
<year>2014</year>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Roman]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gyawali]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Savarino]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ambulatory reflux monitoring for diagnosis of gastroesophageal reflux disease:Update of the Porto consensus and recommendations from international consensus group]]></article-title>
<source><![CDATA[Neurogastroenterol Motil]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Marano]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Pallabazzer]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Solito]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgery or Peroral Esophageal Mytomy for Achalasia]]></article-title>
<source><![CDATA[Medicine]]></source>
<year>2016</year>
<volume>95</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>1-9</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schlottmann]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Luckett]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Fine]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>2017</year>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
