Esophagogastric junction outflow obstruction: Where are we now in diagnosis and management?

Samo, Salih; Qayed, Emad

doi:10.3748/wjg.v25.i4.411

Cited by 53 publications

(28 citation statements)

References 27 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In general, a range of etiologies can be responsible for EGJOO, and management outcomes depend on choosing the correct treatment strategy, which in turn depends on accurate diagnosis and differentiation of functional from mechanical EGJOO. Similar to achalasia, EGJOO shares a common primary abnormality in terms of failure of LES relaxation 17 . Asymptomatic or minimally symptomatic patients often require no treatment due to spontaneous symptom resolution in some patients 18 .…”

Section: Discussionmentioning

confidence: 99%

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

et al. 2020

View full text Add to dashboard Cite

Background and study aims Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown. Patients and methods This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events. Results A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm2/mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B). Conclusions POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.

show abstract

Section: Discussionmentioning

confidence: 99%

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Both achalasia and EGJOO are disorders of esophagogastric junction outflow obstruction 17,18 . However, EGJOO is a newly described entity.…”

Section: Discussionmentioning

confidence: 99%

Esophagogastric junction outflow obstruction: Characterization of a new entity? Clinical, manometric, and neuroimmunological description

Furuzawa‐Carballeda

Coss‐Adame

Romero‐Hernández

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

Objective To determine the differences between clinical, manometric, and neuroimmunological profile of esophagogastric junction outflow obstruction (EGJOO) and achalasia patients. Methods Seven EGJOO and 27 achalasia patients were enrolled in a blind cross‐sectional study. Peripheral blood (PB) of 10 healthy donors and 10 lower esophageal sphincter (LES) muscle biopsies from organ transplant donors were included as controls. The presence of ganglion cells, cells of Cajal, Th22/Th7/Th2/Th1/Tregs/Bregs/pDCregs in tissue, and PB was assessed by immunohistochemistry and flow cytometry. Serum concentration of IL‐22/IL‐17A/IL‐17F/IL‐4/IFN‐γ/IL‐1β/IL‐6/IL‐23/IL‐33/TNF‐α/IL‐10 was determined using bioplex plates. ANAs and antineuronal antibodies were evaluated by immunofluorescence and Western blot. Key Results EGJOO and achalasia patients had lower ganglion cells and cells of Cajal percentage vs. controls, while fibrosis was present only in achalasia patients. EGJOO and controls had lower cell percentage of Th22/Th17/Th2 vs. achalasia. EGJOO tissue had lower Th1/Treg cell number vs. achalasia, but higher levels vs. control group. Bregs and pDCregs percentage was higher in EGJOO vs. control group. Percentage of PB subpopulations in EGJOO was not significantly different from control group. Serum cytokine levels were higher for IL‐1β/IL‐6/TNF‐α, while IL‐17A levels were lower in EGJOO vs. achalasia and control group. EGJOO group was negative for ANAs, while in achalasia group, 54% were positive. GAD65 and PNMa/Ta2 antibodies were present in achalasia, whereas Yo and recoverin were positive in EGJOO group. Conclusions and Inferences Although EGJOO shares some clinical characteristics with achalasia, the neuroimmunological profile is completely different, suggesting that EGJOO might be a different entity.

show abstract

“…2). This necessary update from version 3.0 including supportive testing and clinical correlation was fundamental to preventing overdiagnosis and unnecessary treatment since most individuals with a manometric picture of EJGOO are asymptomatic or have few symptoms which may often resolve spontaneously [25]. A surge in the indication of POEM for EJGOO was indeed seen after Chicago 3.0 [26][27][28].…”

Section: Esophagogastric Junction Outflow Obstructionmentioning

confidence: 99%

Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0)

et al. 2021

View full text Add to dashboard Cite

The Chicago Classification is the most used classification for primary esophageal motility disorders (PEMD). This classification was recently updated to the 4.0 version. This opinion piece focuses on the possible implications for the treatment of PMED determined by the new classification. Chicago Classification 4.0 included two new concepts for the diagnosis of achalasia: (1) type III achalasia diagnosis demands 100% absent peristalsis defined as either failed peristalsis or spasm; (2) ''inconclusive diagnosis of achalasia'' was added as a possibility. Both may decrease unnecessary treatment. Esophagogastric junction outflow obstruction, distal esophageal spasm, and hypercontractile esophagus were only considered clinically significant when correlated to supportive testing and relevant clinical symptoms and in the absence of gastroesophageal reflux disease. This may decrease the surge of treatment, especially peroral endoscopic myotomy, based solely on manometric diagnosis.

show abstract

Esophagogastric junction outflow obstruction: Where are we now in diagnosis and management?

Cited by 53 publications

References 27 publications

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

Esophagogastric junction outflow obstruction: Characterization of a new entity? Clinical, manometric, and neuroimmunological description

Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0)

Contact Info

Product

Resources

About