Esophagogastric Junction Outflow Obstruction: Are We Missing Anything?

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Manometry

Background:

• Esophagogastric junction outflow obstruction (EGJOO) is manometrically defined by elevated integral relaxation pressure (>15 mmHg) without achalasia.
• EGJOO theoretically implies impaired bolus transit and dysphagia, but clinical presentation varies.
• The diagnostic criteria for EGJOO may not fully capture its clinical manifestations.

Purpose of the Study:

• To compare preperistaltic distal esophageal pressure in EGJOO patients with and without dysphagia.
• To evaluate the diagnostic utility of preperistaltic pressure for identifying dysphagia in EGJOO.
• To assess if preperistaltic pressure can enhance the clinical relevance of manometric EGJOO classification.

Main Methods:

• A retrospective analysis of an esophageal functional test database identified patients with EGJOO.
• Patients were stratified into cohorts based on the presence and severity of dysphagia.
• Preperistaltic distal esophageal pressure was measured for individual swallows and compared between groups using the Mann-Whitney U test.

Main Results:

• Of 149 EGJOO patients, 42 (20 without dysphagia, 22 with severe/very severe dysphagia) met inclusion criteria.
• Patients with severe dysphagia exhibited significantly higher median preperistaltic pressures.
• Preperistaltic pressure demonstrated superior sensitivity and specificity for dysphagia compared to integral relaxation pressure.

Conclusions:

• Elevated preperistaltic pressure is a significant finding in EGJOO patients experiencing dysphagia.
• Incorporating preperistaltic pressure into EGJOO diagnostic criteria could improve its clinical applicability.
• This metric may refine manometric classification, better correlating with patient symptoms.