Esophagogastric Junction Outflow Obstruction: Current Approach to Diagnosis and Management

Zikos, Thomas; Triadafilopoulos, George; Clarke, John O.

doi:10.1007/s11894-020-0743-0

Cited by 29 publications

(56 citation statements)

References 42 publications

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“…The causes of EGJOO can generally be classified into four categories: mechanical obstruction, medication-related, functional obstruction, and artifact of no clinical significance. 34 Significant variation in the categories above has been present in the EGJOO series published so far since all the studies are retrospective and further investigations were not performed in all the patients. Among large studies with more than 50 EGJOO patients and with either upper endoscopy or radiologic studies done for more than 75% of the cases, structural 17,27,35 Opiates and esophagogastric junction outflow obstruction The effects of opiates on the gastrointestinal tract have been well studied in the stomach, small intestines, and colon.…”

Section: What Are the Causes Of Egjoo?mentioning

confidence: 99%

“…16 Upper endoscopy should be included as an initial part of the EGJOO work-up in patients who have not had this investigation before to exclude an anatomical etiology and at least six biopsies should be taken from the distal and proximal esophagus. 8,34,38 Endoscopic findings commonly observed in EoE are linear furrows, esophageal rings, pallor/decreased vasculature, white plaques, strictures, and narrow esophagus. 39,40 EoE is a common cause of nonobstructive dysphagia, with a prevalence of 12-22% in prospective studies.…”

Section: Which Investigations Should Be Offered To Patients?mentioning

confidence: 99%

“…Pooled response rates for botulinum toxin, pneumatic dilatation, and POEM are all >60%. However, the response rates for observation and proton pump inhibitor use are also similarly high, 34 raising concerns that aggressive therapy may not be necessary for the majority of patients with EGJOO.…”

Section: What Is the Management Approach For Patients With Egjoo?mentioning

confidence: 99%

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How to approach esophagogastric junction outflow obstruction?

Patcharatrakul

Alkaddour

Pitisuttithum

et al. 2020

Annals of the New York Academy of Sciences

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The diagnosis of esophagogastric junction outflow obstruction (EGJOO) is currently based on high‐resolution esophageal manometry and is characterized by impaired EGJ relaxation with preserved esophageal peristalsis. This condition has been defined by the Chicago Classification as a major esophageal motility disorder, although its clinical significance is controversial since heterogeneous and irrelevant presentations have been reported. EGJOO commonly has a benign clinical course, with spontaneous resolution, but it can also be associated with opioid usage, early achalasia, and mechanical obstruction. A careful medical, surgical, and medication history coupled with a careful manometry interpretation focused on the factors that might affect the integrated relaxation pressure are the keys for an accurate diagnosis. The advance of esophageal physiological tests can evaluate the clearance of the esophageal contents across the EGJ. The manometry technique, including testing in an upright position and provocative tests, can also complement those tests and demonstrate the evidence of EGJ obstruction. After making a diagnosis, endoscopy should be an initial step to exclude anatomical causes if it has not yet been done. Imaging studies can identify infiltrative lesions, but the reported diagnostic yield is relatively low. Management of EGJOO depends on the underlying etiology. Functional EGJOO patients with persistent dysphagia associated with the presence of outflow obstruction may require EGJ disruption therapy.

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Section: What Are the Causes Of Egjoo?mentioning

confidence: 99%

Section: Which Investigations Should Be Offered To Patients?mentioning

confidence: 99%

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How to approach esophagogastric junction outflow obstruction?

Patcharatrakul

Alkaddour

Pitisuttithum

et al. 2020

Annals of the New York Academy of Sciences

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“…Auch bei der ÖGÜ-Obstruktion und denspastischenMotilitätsstörungenwird Botox eingesetzt, weist jedoch niedrige Erfolgsraten als bei der Achalasie auf, weswegen die Leitlinien einen eher zurückhaltenden Einsatz empfehlen [16,20].…”

Section: Injektion Von Botulinumtoxinunclassified

“…Patienten mit Typ-III-Achalasie und Megaösophagus sprechen hingegen nicht gut auf die PD an. Die PD bei UÖS-Obstruktion und spastischen Motilitätsstörungen weist in mehreren Studien eine Erfolgs-rate von 20-60 % auf, was jedoch deutlich unter den dokumentierten Erfolgsraten der Achalasie liegt [8,20].…”

Section: Pneumatische Dilatationunclassified

Motilitätsstörungen des Ösophagus

Heinrich

Gockel

2020

Gastroenterologe

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Motilitätsstörungen des Ösophagus Invasive Therapie Pathogenese und Klassifikationen Funktions-oder Motilitätsstörungen des Ösophagus wie z. B. die Achalasie sind eine Gruppe von Erkrankungen, bei denen es aufgrund einer Veränderung der neuromuskulären Strukturen zu einer Störung des Schluckakts kommt [1]. Es werden primäre von sekundären, durch andere Ursachen bedingten Motilitätsstörungen unterschieden [2]. Die Entwicklung der diagnostisch-hierarchischen Chicago-Klassifikation (. Abb. 1) hat die Diagnose von Ösophagusmotilitätsstörungen und die Wahl der Therapieform verändert [3, 4].

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