ĐẶC ĐIỂM LÂM SÀNG, NỘI SOI, X-QUANG THỰC QUẢN VÀ HRM Ở BỆNH NHÂN RỐI LOẠN VẬN ĐỘNG THỰC QUẢN: KINH NGHIỆM ĐỊNH HƯỚNG ĐIỀU TRỊ TẠI BỆNH VIỆN ĐA KHOA TÂM ANH HÀ NỘI

Abstract

Background: Esophageal motility disorders, particularly achalasia, are rare chronic conditions that may lead to aspiration pneumonia and malnutrition, requiring a multimodal diagnostic approach to guide management.

Objectives: This study aimed to describe clinical, endoscopic, and radiographic characteristics, as well as high-resolution manometry (HRM) findings, and to evaluate treatment-oriented experience across different disease subgroups.

Methods: A descriptive study was conducted on 84 patients diagnosed with esophageal motility disorders using HRM at Tam Anh General Hospital, Hanoi, from August 2022 to April 2026. Clinical features, endoscopic and radiographic findings, HRM classification, and treatment modalities were analyzed.

Results: Achalasia accounted for 63.09% (53/84), ineffective esophageal motility (IEM) 16.67% (14/84), esophagogastric junction outflow obstruction (EGJOO) 16.67% (14/84), and absent contractility (AC) 3.57% (3/84). In the achalasia group, patients treated with pneumatic dilation (PD, n=21) were predominantly type II (90%) and type I (10%), with a mean Eckardt score of 6.67. Patients undergoing peroral endoscopic myotomy (POEM, n=34) had a longer disease duration (5.04 years), more complications, and a subtype distribution of type I:II:III as 12.5%:75%:12.5%. The EGJOO group showed heterogeneous presentations, with a mean Eckardt score of 3.28; most had no obstructive findings on endoscopy. Medical therapy was applied in 86% of cases, while a minority required intervention (PD or POEM). The AC group had a prolonged disease duration ( > 8 years), severe esophageal dilatation, and multiple prior interventions; two-thirds were treated with POEM. The IEM group had a mean Eckardt score of 4.07, largely normal endoscopic findings, and 93% responded to medical treatment.

Conclusions: HRM plays a central role in the diagnosis and classification of esophageal motility disorders. Integration of clinical, endoscopic, and radiographic data facilitates individualized treatment strategies, ranging from medical therapy to interventional procedures such as PD and POEM, thereby improving clinical outcomes.