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Look above the IRP: predicting abnormal confirmatory testing in patients with esophagogastric junction outflow

Alexandra Strauss Starling¹, Shivani U Thanawala¹, Claire A Beveridge²

¹Division of Gastroenterology & Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Therapeutic Advances in Gastroenterology

|December 30, 2024

Abstract

Background:

Esophagogastric junction outflow obstruction (EGJOO) is a manometric diagnosis based on Chicago Classification version 4.0 (CC4.0) that requires confirmatory testing for clinical relevancy. However, it is still unclear which patients will respond to therapy.

Objectives:

To evaluate manometric and clinical predictors of abnormal confirmatory testing for patients with EGJOO.

Design:

This was a prospective observational study of patients with manometric EGJOO and chest pain or dysphagia who underwent confirmatory testing.

Methods:

Patients with EGJOO on manometry were enrolled and underwent timed barium esophagram or endoFLIP. A subset of patients was given validated surveys, including Eckardt scores (ES) and PROMIS-10.

Results:

For patients with a CC4.0 EGJOO diagnosis, abnormal peristalsis (OR = 7.0, 95% CI = 1.01-44.6, p = 0.04) and increases in ES (OR = 2.34 95% CI = 1.13-4.86, p = 0.02) were associated with positive confirmatory testing.

Conclusion:

Patients with potentially actionable EGJOO were more likely to have an abnormal peristaltic subtype of EGJOO or higher ES.

Keywords:

dysphagia esophageal motility disorder esophagogastrojunction

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