Background: Patients with achalasia suffer from dysphagia and other esophageal symptoms (in the clinical setting captured with the Eckhardt score), but extraesophageal symptoms frequently also occur. Thus, we aimed to assess esophageal and extraesophageal symptoms in achalasia patients before and after Peroral Endoscopic Myotomy (POEM) and the link to the type (or stage) of achalasia. Methods: 52 consecutive patients with a confirmed achalasia diagnosis at one center who underwent POEM between 2015-2021 were included. Gastroin-testinal (GI) and extraintestinal symptoms were assessed by the validated SAGIS (Structured Assessment of GI Symptoms Instrument) total score and subscores (dysphagia, nausea/vomiting, epigastric symptoms, diarrhea, constipation) as well as the Eckardt score calculated before and one year after POEM. In addition, based upon symptoms, a SAGIS heatmap was used to visualize changes in symptoms. To compare POEM responders and non-responders, an Eckardt score of >4 post-POEM was applied to identify non-responders. Results: Mean age of the patients cohort was 48 years (63% males), including 14 type I (27%), 29 type II (56%), and 9 type III (17%) achalasia. Seven out of 52 patients showed partial response to POEM (3/7 type II,4/7 type III) and POEM resulted in significant improvement of SAGIS subscore for dysphagia in types I and II (type I:baseline 5.5±2.25 vs 1.43±1.87,p=0.007; type II:baseline 6.45±3.03 vs 2.79±2.3,p=0.0001,figure 1), but not in type III. In addition, only type II had significant improvement in SAGIS subscores for nausea/vomiting (baseline 6.38±4.59 vs 1.9±3.32,p=0.0001) and epigastric symptoms (baseline 10.93±6.66 vs 3.83±4.49,p=0.0005) post-POEM. Diarrhea and constipation subscores did not improve post-POEM in all types. At baseline, all achalasia types had similar scores for extraesophageal symptoms with the exception of diarrhea which was significantly worse in type III compared to type I (type III 8.11±5.28 vs type I 1.14±1.99,p=0.008). From type I to II and from type II to III, there were increased extraintestinal symptoms (fatigue, joint pain, psychological comorbidities) and total SAGIS score at baseline and post-POEM, which were linked to higher Eckardt scores after POEM (P<0.02). The SAGIS heatmap (figure 2) qualitatively demonstrated different symptom patterns for each type involving esophageal and non-esophageal symptoms and gross clinical improvement post-POEM. Conclusion: Extraeso-phageal symptoms are prevalent in patients with achalasia and improve after treatment with POEM. SAGIS is suitable to capture gastrointestinal and extraintestinal symptoms of achalasia patients and a SAGIS heatmap is a novel approach to visualize improvement of multiple GI symptoms following therapeutic interventions.