ĐÁNH GIÁ TRÀO NGƯỢC DẠ DÀY – THỰC QUẢN SAU POEM Ở BỆNH NHÂN CO THẮT TÂM VỊ TẠI BỆNH VIỆN ĐA KHOA TÂM ANH, HÀ NỘI

Abstract

Background: Peroral endoscopic myotomy (POEM) is an effective and minimally invasive treatment for achalasia. However, gastroesophageal reflux disease (GERD) remains a major concern after the procedure, with widely varying reported rates across recent studies. This study aimed to evaluate the incidence of GERD after POEM using both symptom-based and endoscopic assessments, and to analyze associated factors.

Objectives: To evaluate the incidence, clinical characteristics, and associated factors of GERD after POEM in patients with achalasia.

Methods: This retrospective study included 36 patients with achalasia who underwent POEM at Tam Anh General Hospital Hanoi, between 2021 and 2026. Post-POEM GERD was defined based on clinical symptoms using the GERD-Q score (≥8) and/or endoscopic findings according to the Los Angeles classification (≥ grade A). “Silent GERD” was defined as endoscopic esophagitis in the absence of symptoms. Agreement between GERD-Q and endoscopic findings was assessed using the Kappa coefficient. Associations between clinical or endoscopic GERD and potential factors were analyzed using univariate logistic regression.

Results: A total of 36 patients were included, with a mean age of 46,3 ± 15,7 years; 41,7% were male; mean BMI was 21,0 ± 3,8 kg/m²; and achalasia type II was the most common subtype (69,4%). After a median follow-up of 12 months, 9 patients (25,0%) reported reflux symptoms. Among 22 patients who underwent follow-up endoscopy, 13 (59,1%) had reflux esophagitis, predominantly mild (grades A–B in 76,9%). The agreement between GERD-Q and endoscopic findings was low (κ = 0.34), indicating poor concordance between symptoms and mucosal injury. Silent GERD was observed in 61.5% of patients with endoscopic esophagitis. Type I and II achalasia were associated with a significantly lower risk of symptomatic GERD following POEM (p = 0.006). A trend toward increased risk of GERD was observed in patients with BMI ≥ 23 kg/m², although these did not reach statistical significance. No statistically significant associations were found between GERD and age, sex or pre-POEM interventions.

Conclusions: GERD is common after POEM, with a substantial proportion of patients showing endoscopic findings even in the absence of symptoms, although severity is generally mild. Type I and II achalasia reduce the symptoms of GERD, and no other independent risk factors were identified, possibly due to the small sample size. Routine endoscopic follow-up should be considered after POEM.