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IMPACT OF FOOD INSECURITY ON POSTOPERATIVE OUTCOMES OF ESOPHAGEAL PERORAL ENDOSCOPIC MYOTOMY AT A LARGE TERTIARY INSTITUTION
Adithya J. Menon
*1, Dalton A. Norwood
2, Ryan T. Griffin
1, Sergio A. Sánchez-Luna
3, Kristen Wong
41The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; 2Division of General Internal Medicine & Population Science, University of Alabama at Birmingham, Birmingham, AL; 3Basil I. Hirschowitz Endoscopic Center of Excellence, Department of Internal Medicine – Division of Gastroenterology & Hepatology, University of Alabama at Birmingham, Birmingham, AL; 4Department of Surgery – Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL
Background: Esophageal peroral endoscopic myotomy (E-POEM) has significantly advanced the treatment of achalasia. However, the impact of socioeconomic determinants of health, such as food insecurity (FI), on E-POEM outcomes remains underexplored. The lack of consistent access to adequate nutrition may contribute to achalasia symptoms and influence post-intervention outcomes. Integrating clinical outcomes with social determinants of health would enable a more holistic understanding; therefore, this study aims to explore the relationship between FI and E-POEM outcomes, specifically regarding symptom reduction, distensibility index (DI), and objective gastroesophageal reflux measures.
Methods: A retrospective analysis was conducted on patients who underwent E-POEM at our tertiary referral center from 2019 to the present. Patient addresses were utilized to identify low income and low food access (LI/LA) using the USDA Food Access Research Atlas and the degree of socioeconomic disadvantage on the Area Deprivation Index (ADI) through the Neighborhood Atlas. Patients' symptoms were scored with the Eckardt score (ES). Physiological changes in lower esophageal sphincter (LES) pressure pre- and post-POEM were assessed with an endoluminal functional lumen imaging probe (FLIP). Patients underwent EGD with ambulatory pH monitoring approximately one year after POEM, where the presence of esophagitis was noted, along with the DeMeester score (DMS). Analysis of patient demographics, procedural characteristics, and outcomes included two-sample t-tests and chi-squared tests, with p?0.05 indicating statistical significance.
Results: A total of 109 patients were included in the analysis. 53.3% (n=57) of patients had an ADI score >75, indicating placement in the top national quartile (25%) of socioeconomic disadvantage. LI/LA was identified in 32.1% (n=35) of patients compared to 30.6% of the U.S. population, though LI/LA was not significantly influenced by sex or BMI. There was no significant difference in the improvement of ES between these cohorts (-7.17 in patients with LI/LA vs. -7.28 without, p=0.874). Notably, patients with ADI>75 exhibited a significantly decreased postoperative DI
max on FLIP (5.05 vs. 7.07, p=0.047). Patients with LI/LA also demonstrated this relationship (4.59 vs. 6.41, p=0.035), along with a decreased DMS (16.4 vs. 32.3, p=0.081) and a lower overall rate of esophagitis in postoperative EGD (10% vs. 34.2%, p=0.132).
Conclusion: Food insecurity is more prevalent among our patients undergoing E-POEM than in the general population, showing a negative relationship between FI and DI
max post-POEM. This correlates with FI leading to lower rates of esophagitis and lower DMS on postoperative testing. Ultimately, FI may serve as a predictor of post-POEM outcomes, but establishing a causal relationship requires further exploration.
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