Gender differences of Chinese achalasia patients in symptoms, high-resolution manometry values and efficacy of peroral endoscopic myotomy (POEM).

AIM Some studies indicated that gender may affect esophageal motility. In addition, estrogen may exert an influence on esophageal diseases. Achalasia is also a disease involving esophageal motility abnormalities and POEM is a novel treatment. Thus, we aimed to figure out gender differences in symptoms, HRM characteristics, and efficacy of POEM in achalasia patients. METHODS All patients who were diagnosed with achalasia by HRM underwent POEM and were followed up for more than six months after POEM. We compared the demographic characteristic, symptoms, POEM data, HRM characteristics and possible associated complications between male and female patients. RESULTS 1) Prior to POEM, dysphagia was more severe in female patients than that of male patients (P=0.044). In contrast, regurgitation was more severe (P=0.013) and heartburn was more common in male patients (P=0.003). Regarding HRM characteristics, in female achalasia patients, the LESP was higher (P=0.01) and esophageal length was shorter compared with male patients. 2) After POEM, The postoperative Eckardt scores, LESP and IRP were significantly lower than the preoperative ones (P<0.001). No significant difference was observed between genders among the efficacy of POEM, reflux symptoms, HRM data and complications after POEM. CONCLUSIONS Before seeking any treatment, female achalasia patients may experience more severe dysphagia and male patients are more likely to undergo heartburn and more severe regurgitation. Estrogen may play an important role in the elevated LESP in female patients before POEM. POEM is a safe and effective option for the treatment of both male and female achalasia patients.