Tesis

Kejadian Penyakit Refluks Gastroesofageal Pada Pasien Akalasia Pasca Peroral Endoscopic Myotomy dan FaktorFaktor yang Berhubungan = Gastroesophageal Reflux Disease in Achalasia Patients After Peroral Endoscopic Myotomy and Its Associated Factors.

Latar belakang: Peroral Endoscopic Myotomy (POEM) merupakan terapi lini utama bagi pasien akalasia dan varian Esophagogastric Junction Outflow Obstruction (EGJOO). Meskipun POEM efektif mengurangi gejala disfagia, terdapat kekhawatiran mengenai peningkatan risiko penyakit refluks gastroesofageal (GERD) pasca tindakan ini. Tujuan: Mengetahui proporsi kejadian GERD antara pasien akalasia tipe klasik dan varian EGJOO setelah POEM, serta mengevaluasi faktor-faktor yang berhubungan dengan kejadian GERD pasca tindakan POEM. Metode: Penelitian potong lintang menggunakan data primer dan sekunder dari pasien akalasia tipe klasik dan EGJOO yang telah menjalani POEM di RSUPN Dr. Cipto Mangunkusumo periode 2017–2024. Data dikumpulkan melalui wawancara dan rekam medis. Kejadian GERD dievaluasi menggunakan skor GERD-Q. Analisis bivariat dan multivariat regresi logistik untuk mengidentifikasi faktor yang berhubungan. Hasil: Sebanyak 83 subjek penelitian terdiri dari 68 pasien akalasia tipe klasik dan 15 pasien varian EGJOO. Proporsi GERD pasca POEM sebesar 36,8% pada akalasia tipe klasik dan 53,3% pada varian EGJOO. Analisis multivariat menunjukkan bahwa usia ≥60 tahun (OR 5.68; 95% IK 1.17–27.65; p=0.03), riwayat dilatasi esofagus (OR 5.43; 95% IK 1.77–16.68; p=0.003), obesitas (OR 3.95; 95% IK 1.23–12.76; p=0.02), dan nilai integrated relaxation pressure (IRP) tinggi (OR 1.05 per mmHg; 95% IK 1.00–1.10; p=0.03) berhubungan secara bermakna dengan kejadian GERD pasca POEM. Kesimpulan: Kejadian GERD pasca POEM tinggi pada kedua kelompok pasien. Faktor usia lanjut, riwayat dilatasi, obesitas, dan nilai IRP tinggi sebelum POEM merupakan faktor independen yang berhubungan dengan kejadian GERD.
Kata kunci: Akalasia, EGJOO, POEM, GERD, faktor yang berhubungan.


Background: Peroral Endoscopic Myotomy (POEM) has become a first-line treatment for patients with achalasia and Esophagogastric Junction Outflow Obstruction (EGJOO). Although POEM is effective in relieving dysphagia, concerns remain about the increased risk of gastroesophageal reflux disease (GERD) after the procedure. Objective: To evaluate the incidence of GERD between patients with classical achalasia and EGJOO after POEM and to identify associated factors with postPOEM GERD. Methods: A cross-sectional study included primary and secondary data from classical achalasia and EGJOO patients who underwent POEM at Dr. Cipto Mangunkusumo National General Hospital between 2017 and 2024. Data were collected through interviews and medical record. GERD was assessed using the GERD-Q questionnaire. Bivariate and multivariate logistic regression analyses were conducted to determine asscociated factors. Results: A total of 83 subjects were included, consisting of 68 patients with classical achalasia and 15 with EGJOO. The proportion of GERD post-POEM was 36.8% in the classical achalasia and 53.3% in the EGJOO. Multivariate analysis showed that age ≥60 years (OR 5.68; 95% CI 1.17–27.65; p=0.03), prior esophageal dilation (OR 5.43; 95% CI 1.77–16.68; p=0.003), obesity (OR 3.95; 95% CI 1.23–12.76; p=0.02), and high pre-POEM Integrated Relaxation Pressure (OR 1.05 per mmHg; 95% CI 1.00–1.10; p=0.03) were significantly associated with GERD occurrence. Conclusion: GERD is common after POEM in both classical achalasia and EGJOO patients. Advanced age, prior dilation, obesity, and high IRP before POEM are independent associated factors of GERD.
Keywords: Achalasia, EGJOO, POEM, GERD, associated factors.