Low-Dose Amitriptyline as Adjunct Therapy for Residual Symptoms Following Peroral Endoscopic Myotomy in Achalasia: A Prospective, Open-Label Randomized Controlled Trial

Peroral endoscopic myotomy (POEM) is a successful treatment for achalasia, but approximately 10 to 40 percent of patients experience residual symptoms like chest pain or dysphagia. These symptoms often occur without objective evidence of obstruction, suggesting visceral hypersensitivity. Low-dose amitriptyline is a neuromodulator with established efficacy in functional esophageal disorders. This randomized trial aims to evaluate if adding low-dose amitriptyline to standard acid suppression therapy improves symptoms better than acid suppression alone. We hypothesize that targeting hypersensitivity will significantly reduce the total Eckardt score over 12 weeks.