Evaluation of symptomatic esophagogastric junction outflow obstruction

Ong, Andrew Ming-Liang; Namasivayam, Vikneswaran; Wang, Yu Tien

doi:10.1111/jgh.14155

Cited by 22 publications

(39 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this study, we found that about one out of eight patients undergoing evaluation with HRM with water swallows in the recumbent position had an isolated elevation in IRP, raising the possibility of an outflow obstruction. This prevalence is similar to that reported at other centers . However, in two‐thirds of these patients the elevated IRP was not associated with an elevated IBP and/or the elevated IRP disappeared on swallows in the sitting position, findings indicating that the high IRP did not result from true EGJOO.…”

Section: Discussionsupporting

confidence: 88%

“…EGJOO is identified by impaired EGJ relaxation and preserved peristalsis such that criteria for achalasia are not met . The prevalence of EGJOO in several case series has ranged between 3% and 17% of manometry patients, and dysphagia was reported as the predominant symptom in these patients . Proposed etiologies of EGJOO in CCv3 include mechanical obstruction, cardiovascular compression, early achalasia, and potentially hiatal hernia .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacologic interrogation of patients with esophagogastric junction outflow obstruction using amyl nitrite

Babaei

Shad

Szabó

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background The Chicago Classification of esophageal motility includes a group of patients who show evidence of esophagogastric junction outflow obstruction (EGJOO) as demonstrated by elevated integrated relaxation pressure (IRP) and preserved peristalsis. Our aim is to classify EGJOO patients based on response to amyl nitrite (AN) during high‐resolution manometry. Methods Patients were considered to have true EGJOO if elevated IRP during supine swallow persisted in the upright position and was associated with high intrabolus pressure. The EGJ response to AN was compared between patients with achalasia type 2 (A2) and normal esophageal motility. Based on the relaxation gain (deglutitive IRP—AN IRP) value that best discriminated these two groups (10 mm Hg), patients with true EGJOO were categorized as being in either the AN‐responsive (AN‐R) or AN‐unresponsive (AN‐U) subgroups. Key Results In the group of 49 patients with true EGJOO, the AN response classified 27 patients (IRP = 25 ± 10 mm Hg) with AN‐R and 22 patients (IRP = 20 ± 5 mm Hg) with AN‐U (P = 0.2). In AN‐R, AN produced a relaxation gain and rebound after‐contraction response at the EGJ comparable to A2 patients. AN‐U patients had an elevated IRP after AN and a relaxation gain similar to normal esophageal motility patients. AN‐U patients were obese and had higher prevalence of sleep apnea (P < 0.05). Conclusions Among patients with true EGJOO, only half have pharmacologic evidence of impaired LES relaxation. Pharmacologic interrogation of the EGJ is thus necessary to identify the subgroup of EGJOO patients who could be expected to benefit from LES ablative therapies.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Pharmacologic interrogation of patients with esophagogastric junction outflow obstruction using amyl nitrite

Babaei

Shad

Szabó

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…Conversely, Ong et al reported that in their cohort of 40 EGJOO patients, CT scans and EUS identified infiltrating diseases of the esophagus not seen on endoscopy in two patients, one with previously known metastatic adenocarcinoma of the breast. This suggests that the threshold for performing further testing in newly diagnosed EGJOO patients should be guided by clinical examination and significantly lowered in the setting of already known metastatic processes and common signs and symptoms associated with them.…”

Section: Discussionmentioning

confidence: 93%

“…In a study by Perez‐Fernandez et al looking at 28 patients with EGJOO compared to a control group, 40% had spontaneous symptom resolution despite no specific treatment at 6‐month follow‐up. In a separate study, Ong et al reported that in a series of 40 patients with EGJOO, 25 or 62% of these patients had spontaneous resolution of their symptoms with simply dietary changes or reassurance. Further, van Hoeij et al reported that in a series of 34 patients with primary EGJOO, 26 or 76% of them did not require treatment because of either spontaneous symptom resolution, symptoms not deemed secondary to the EGJOO, or refusal of treatment, concluding that watchful waiting is not an unreasonable option.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that the vast majority of the anatomical lesions mentioned above would be identified on initial upper endoscopy. Regardless, some authors argue that an EGJOO diagnosis mandates further aggressive investigations, including endoscopic ultrasonography (EUS), functional luminal imaging probe (FLIP), or computed tomography (CT), to rule out malignant etiologies . These recommendations are merely expert opinion and not rooted in evidence.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Esophagogastric junction outflow obstruction on manometry: Outcomes and lack of benefit from CT and EUS

Liu

Woo

Nasser

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background Esophagogastric junction outflow obstruction (EGJOO) is a manometric diagnosis based on the Chicago Classification defined by inadequate relaxation of the gastroesophageal junction (GEJ) with swallowing, but with sufficient peristalsis such that the criteria for achalasia are not met. Possible causes include anatomical and functional etiologies. Further investigations, including computed tomography (CT) of the chest and endoscopic ultrasound (EUS), to help elucidate the etiology of EGJOO have been suggested, but the utility of this approach has not been proven. Methods All new diagnoses of EGJOO made in the calendar years 2015‐2016 were included. A review was performed for each patient to assess clinical outcomes, diagnostic, and therapeutic interventions after the EGJOO diagnosis. Key Results 107 EGJOO patients were included. Their primary complaints were dysphagia (68%), chest pain (12%), reflux (8%), pre‐operative assessment (6%), regurgitation (3%), and cough (3%). The mean IRP was 21.8 mm Hg. After a mean follow‐up period of 463 days, the etiology of EGJOO remained undetermined in 67% of patients. 48% of patients were investigated with cross‐sectional imaging (and 10% with EUS to rule out external compression or malignancy as a cause of EGJOO; none of these tests provided any further useful information). In only two cases did the EGJOO progress to achalasia. Conclusions & Inferences EGJOO is a manometric diagnosis with unclear clinical significance and outcome. CT and EUS of the GEJ were unhelpful at determining the cause of this entity. In this series, very few appear to progress to achalasia, none were due to malignancy, and many resolved spontaneously.

show abstract

Integrated Relaxation Pressure and Its Diagnostic Ability May Vary According to the Conditions Used for HREM Recording

do Carmo,

de Assis Mota,

da Silva Castro Perdoná

et al. 2024

Dysphagia

View full text Add to dashboard Cite

Evaluation of symptomatic esophagogastric junction outflow obstruction

Cited by 22 publications

References 19 publications

Pharmacologic interrogation of patients with esophagogastric junction outflow obstruction using amyl nitrite

Pharmacologic interrogation of patients with esophagogastric junction outflow obstruction using amyl nitrite

Esophagogastric junction outflow obstruction on manometry: Outcomes and lack of benefit from CT and EUS

Integrated Relaxation Pressure and Its Diagnostic Ability May Vary According to the Conditions Used for HREM Recording

Contact Info

Product

Resources

About