Characterization of idiopathic esophagogastric junction outflow obstruction

Hoeij, Froukje B. van; Smout, A. J. P. M.; Bredenoord, Albert J.

doi:10.1111/nmo.12625

Cited by 138 publications

(195 citation statements)

References 13 publications

(63 reference statements)

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“…Similar findings are found also in patients with dysphagia after restrictive, antireflux and bariatric procedures [45][46][47] . However, two series published in the past few years found that many patients with EGJOO were minimally symptomatic or asymptomatic, that in 20-40% of cases the 'disorder' resolved spontaneously, and that only 12-40% were treated (conservatively) as having achalasia 48,49 .…”

Section: Achalasia With Preserved Peristalsismentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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Section: Achalasia With Preserved Peristalsismentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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“…16,35 It has been reported to be a result of an infiltrative disease, or a variant or incomplete onset of achalasia. 36,37 However, EGJ outflow obstruction is a clinically unclear disorder. In some patients, the symptoms are similar to achalasia with good effect of achalasia treatment, whereas in other patients the symptoms disappear spontaneously or are not related to an outflow obstruction.…”

Section: 32mentioning

confidence: 99%

“…In some patients, the symptoms are similar to achalasia with good effect of achalasia treatment, whereas in other patients the symptoms disappear spontaneously or are not related to an outflow obstruction. 36,37 The current advice is to use subsequent diagnostic tests to identify patients with "true" outflow obstruction and stasis and distinguish them from patients with a coincidental finding of high IRP. Patients with true outflow obstruction should be treated with achalasia therapy.…”

Section: 32mentioning

confidence: 99%

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders

Hoeij

Bredenoord

2015

J Neurogastroenterol Motil

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Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional manometry. The visual presentation of acquired data improved the analysis and interpretation of esophageal motor function. This led to a more sensitive, accurate, and objective analysis of esophageal motility. In this review we discuss how HRM changed the way we define and categorize esophageal motility disorders. Moreover, we discuss the clinical applications of HRM for each esophageal motility disorder separately. (J Neurogastroenterol Motil 2016;22:6-13)

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“…Both botulinum injection and PD showed good relief of dysphagia but with ephemeral duration. 15 Scherer and colleagues, 16 among 1000 HRM diagnosed 16 patients (1.6%) with EGJ outflow obstruction and treated them with botulinum toxin injection, PD or LHM. Only the 3 patients treated with LHM responded well.…”

Section: Esophagogastric Junction Outflow Obstructionmentioning

confidence: 99%

Understanding the Chicago Classification: From Tracings to Patients

Schlottmann

Herbella

Patti

2017

J Neurogastroenterol Motil

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Current parameters of the Chicago classification include assessment of the esophageal body (contraction vigour and peristalsis), lower esophageal sphincter relaxation pressure, and intra-bolus pressure pattern. Esophageal disorders include achalasia, esophagogastric junction outflow obstruction, major disorders of peristalsis, and minor disorders of peristalsis. Sub-classification of achalasia in types I, II, and III seems to be useful to predict outcomes and choose the optimal treatment approach. The real clinical significance of other new parameters and disorders is still under investigation. (J Neurogastroenterol Motil 2017;23:487-494)

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Characterization of idiopathic esophagogastric junction outflow obstruction

Abstract: Primary EGJ outflow obstruction has an unclear clinical significance. A substantial part of patients has unrelated symptoms, spontaneous symptom relief, or no stasis. Treated patients showed a beneficial response to botox injections. A small proportion develops achalasia at follow-up.

Cited by 138 publications

References 13 publications

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders

Understanding the Chicago Classification: From Tracings to Patients

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