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Review
. 2019 Jan 28;25(4):411-417.
doi: 10.3748/wjg.v25.i4.411.

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

Salih Samo  1 , Emad Qayed  2
Affiliations
Review

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

Salih Samo et al. World J Gastroenterol. .

Abstract

Esophagogastric junction outflow obstruction (EGJOO) is a major motility disorder based on the Chicago Classification of esophageal motility disorders. This entity involves a heterogenous group of underlying etiologies. The diagnosis is reached by performing high-resolution manometry. This reveals evidence of obstruction at the esophagogastric junction, manifested by an elevated integrated relaxation pressure (IRP) above a cutoff value (IRP threshold varies by the manometric technology and catheter used), with preserved peristalsis. Further tests like endoscopy, timed barium esophagram, and cross-sectional imaging can help further elucidate the underlying etiology and rule out mechanical causes. Treatment is tailored to the underlying cause. Similar to achalasia, treatment targeting lower esophageal sphincter disruption like pneumatic dilation, peroral endoscopic myotomy, and botulinum injection are used in patients with functional EGJOO and persistent symptoms.

Keywords: Esophagogastric junction outflow obstruction; High-resolution manometry.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
High-resolution manometry image. Panel A represents a normal high-resolution manometry (HRM) image of the esophagus with normal integrated relaxation pressure of 6 mmHg. Panel B represents an HRM image of esophagogastric junction outflow obstruction with IRP of 20 mmHg and reserved peristalsis.
Figure 2
Figure 2
A proposed algorithm for the management of esophagogastric junction outflow obstruction. HRM: High resolution manometry; TBE: Time barium swallow; LES: Lower esophageal sphincter; EGJOO: Esophagogastric junction outflow obstruction; DCI: Distal contractile integral; IRP: Integrated relaxation pressure; PPI: Proton pump inhibitor.
See this image and copyright information in PMC

References

    1. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–174. - PMC - PubMed
    1. Ghosh SK, Pandolfino JE, Rice J, Clarke JO, Kwiatek M, Kahrilas PJ. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol. 2007;293:G878–G885. - PubMed
    1. do Carmo GC, Jafari J, Sifrim D, de Oliveira RB. Normal esophageal pressure topography metrics for data derived from the Sandhill-Unisensor high-resolution manometry assembly in supine and sitting positions. Neurogastroenterol Motil. 2015;27:285–292. - PubMed
    1. Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE. Advances in Management of Esophageal Motility Disorders. Clin Gastroenterol Hepatol. 2018;16:1692–1700. - PMC - PubMed
    1. Okeke FC, Raja S, Lynch KL, Dhalla S, Nandwani M, Stein EM, Chander Roland B, Khashab MA, Saxena P, Kumbhari V, Ahuja NK, Clarke JO. What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center. Neurogastroenterol Motil. 2017;29 - PubMed

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