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How to approach esophagogastric junction outflow obstruction?
Tanisa Patcharatrakul1,2, Ahmad Alkaddour3, Panyavee Pitisuttithum4
1Center of Excellence on Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Annals of the New York Academy of Sciences
|June 20, 2020
Summary
Esophagogastric junction outflow obstruction (EGJOO) diagnosis requires careful manometry interpretation. Management depends on the cause, with some patients needing EGJ disruption therapy for persistent dysphagia.
Area of Science:
- Gastroenterology
- Esophageal Motility Disorders
Background:
- Esophagogastric junction outflow obstruction (EGJOO) is a major esophageal motility disorder.
- Its clinical significance is debated due to heterogeneous presentations and a commonly benign course.
Purpose of the Study:
- To review the diagnostic criteria and clinical significance of EGJOO.
- To outline the diagnostic approach and management strategies for EGJOO.
Main Methods:
- High-resolution esophageal manometry is the primary diagnostic tool.
- Diagnosis involves careful history, manometry interpretation, and potentially provocative tests.
- Endoscopy and imaging studies aid in excluding anatomical causes.
Main Results:
- EGJOO is characterized by impaired EGJ relaxation with preserved peristalsis.
- It can be associated with opioid use, early achalasia, or mechanical obstruction.
- Functional EGJOO with dysphagia may necessitate EGJ disruption therapy.
Conclusions:
- Accurate EGJOO diagnosis hinges on meticulous manometry interpretation and clinical correlation.
- Management strategies are etiology-dependent, ranging from observation to intervention.
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