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Classification for esophagogastric junction (EGJ) complex based on physiology.

S Akimoto1, S Singhal1,2, T Masuda1,2

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Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus
|July 28, 2018
PubMed
Summary
This summary is machine-generated.

A new classification for the esophagogastric junction (EGJ) combines physiology and morphology. Type-C EGJ, characterized by anatomical and physiological deterioration, shows the weakest lower esophageal sphincter function and is linked to pathological reflux.

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • High-Resolution Manometry

Background:

  • The esophagogastric junction (EGJ) classification is crucial for understanding foregut motility disorders.
  • Existing classifications, such as Chicago v 3.0, may not fully capture the complex interplay of physiological and morphological factors at the EGJ.

Purpose of the Study:

  • To propose and validate a novel classification system for the esophagogastric junction (EGJ) that integrates both physiological and morphological characteristics.
  • To compare this new classification with the established Chicago v 3.0 EGJ classification.

Main Methods:

  • A prospective database of patients undergoing high-resolution manometry (HRM) and pH-study was queried.
  • Patients were classified into Type-A, Type-B, and Type-C based on EGJ morphology and pressure inversion point (PIP).
  • Exclusion criteria included prior foregut intervention, acid suppression, esophageal dysmotility, or significant crural diaphragm separation.

Main Results:

  • A total of 214 patients were classified: Type-A (n=101), Type-B (n=32), and Type-C (n=81).
  • Type-C patients exhibited significantly lower abdominal length, lower esophageal sphincter pressure (LESP), and lower esophageal sphincter pressure integral (LESPI) compared to Type-A and Type-B.
  • Type-C patients also had a significantly higher positive pH score, indicating a higher likelihood of pathological reflux.

Conclusions:

  • The proposed EGJ classification effectively integrates physiological and morphological derangements in a graded manner.
  • Type-C EGJ morphology represents a significant anatomical and physiological deterioration, characterized by the weakest lower esophageal sphincter function.
  • This classification is strongly associated with pathological reflux, offering a more comprehensive understanding of EGJ disorders.