Background
Esophagogastric junction (EGJ) outflow obstruction is a manometric diagnosis, characterized by an elevated relaxation pressure (IRP4) of the lower esophageal sphincter (LES) and intact or weak peristalsis. The etiology and preferred treatment remain unknown. We describe a large patient cohort in detail, for a better understanding of this rare disorder.
Methods
We included 47 patients, diagnosed with EGJ outflow obstruction on high‐resolution manometry (HRM) between 2012 and December 2014.
Key Results
Idiopathic EGJ outflow obstruction was diagnosed in 34 patients. The majority (91%) of patients presented with retrosternal pain or dysphagia. The median (IQR) for various HRM parameters was IRP4, 18.9 mmHg (18–23); intrabolus pressure (IBP), 8.3 mmHg (5–12) and basal LES pressure, 27.5 mmHg (22–33). Peristaltic breaks were seen in 88% and elevated IBPmax in 74% of patients. No patients had stasis, difficult LES passage or esophageal dilation on endoscopy. Only 7/25 patients (28%) had stasis on barium esophagography. In 26 patients (82%), no treatment was required: 18 had symptoms judged unrelated to outflow obstruction, 5 had spontaneous symptom relief, and 3 declined therapy. Eight patients were treated: five received botox injections with a good but short‐lived effect, three received pneumatic dilatation, of which one was successful. Three patients were diagnosed with achalasia on a subsequent manometry.
Conclusions & Inferences
Primary EGJ outflow obstruction has an unclear clinical significance. A substantial part of patients has unrelated symptoms, spontaneous symptom relief, or no stasis. Treated patients showed a beneficial response to botox injections. A small proportion develops achalasia at follow‐up.