Obesity Impacts the Likelihood of Symptom Resolution in Patients with Esophagogastric Junction Outflow Obstruction

Abstract

Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterised by an elevated integrated relaxation pressure (IRP) with preserved peristalsis. Most functional EGJOO symptoms are self-limiting. This study aimed to evaluate the risk factors associated with non-resolution of symptoms for functional EGJOO. A retrospective single institution cohort study was performed on patients diagnosed with functional EGJOO on high-resolution manometry (HRM). Clinical, demographic, endoscopic and imaging parameters were recorded. Univariate and multivariate analyses were performed to identify factors associated with reduced likelihood of symptom resolution. Time to symptom resolution was then plotted on a Kaplan-Meier survival analysis. Over a 5-year period, 53 patients (41.5% male, 58.5% female) were diagnosed with functional EGJOO. The median age, body mass index and IRP at 4 s were 47.0 years (interquartile range (IQR): 36.0-58.0), 23.3 kg/m² (IQR: 20.9-26.5) and 39.9 mmHg (IQR: 28.6-52.3) respectively. Dysphagia and atypical chest pain accounted for 36.5% and 21.2% of symptoms respectively. On the univariate analysis, obesity (p = 0.002), heartburn (p = 0.098) and lack of epigastric pain (p = 0.090) were potentially correlated with failure of symptom resolution. In the multivariate analysis, only obesity (OR 0.11, 95% CI: 0.02-0.77; p = 0.026) was significantly associated with reduced likelihood of symptom resolution for EGJOO. On the survival analysis, 87.2% of non-obese patients, in contrast 37.5% of obese patients reported symptom resolution at up to 41-month follow-up period (p = 0.039). Patients with obesity are at an increased likelihood of having persistent symptoms. This association appeared to persist for patients with both manometric and clinically relevant EGJOO.

Keywords: Esophageal achalasia; Esophageal motility disorders; Obesity; Symptom assessment.