A patient with achalasia bleeding from a hyperplastic polyp caused by long- term oral administration of gastric acid secretion inhibitors after per-oral endoscopic myotomy
Since gastroesophageal reflux disease occurs in a certain percentage of patients with esophageal achalasia after per-oral endoscopic myotomy (POEM), long-term administration of gastric acid secretion inhibitors is required in some cases. Prolonged use of gastric acid secretion inhibitors is associated with the development of gastric polyps, including hyperplastic polyps. This study reports the case of a 70-year-old female with esophageal achalasia and bleeding from gastric hyperplastic polyps after POEM, followed by long-term administration of gastric acid secretion inhibitors to prevent reflux esophagitis. One month after the surgery, she took potassium competitive acid blocker (P-CAB). She had no more heartburn symptoms. She decided to stop taking P-CAB on her own. Three months later, symptom of heartburn became severe, and she underwent esophagogastroduodenoscopy (EGD), which showed Los Angeles classification grade C reflux esophagitis. Administration of P-CABs was resumed and the reflux esophagitis resolved rapidly, but despite continued administration of P-CAB, the anemia progressed after 4 years. EGD results showed that the reflux esophagitis had resolved, but bleeding from a newly developed hyperplastic polyp was noted after P-CAB administration.
