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Pedro F Pereira, Andre Rp Rosa, Leonardo A Mesquita, Marcelle J Anzolch, Rafael N Branchi, Augusto L Giongo, Francisco C Paixão, Marcio F Chedid, Cleber Dp Kruel
BACKGROUND: Esophagogastric junction outflow obstruction (EGJOO) is a rare syndrome, characterized by an elevation of the integrated relaxation pressure of the lower esophageal sphincter, not accompanied by alterations in esophageal motility that may lead to the criteria for achalasia. We were unable to find any prior report of the combination of Heller myotomy with anterior partial fundoplication (Dor) as the treatment for EGJOO. We herein report a case of EGJOO treated with laparoscopic Heller myotomy combined with Dor fundoplication...
February 27, 2019: World Journal of Gastrointestinal Surgery
Pierre Blais, Michael C Bennett, C Prakash Gyawali
BACKGROUND: Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM), particularly nadir UES residual pressure (UES-RP), are abnormal in achalasia and may help characterize the underlying mechanism or predict management outcome in esophagogastric junction outflow obstruction (EGJOO). METHODS: A database of consecutive patients undergoing esophageal HRM from 2008 to 2013 yielded 134 patients (59.8 ± 1.4 years, 68% F) with EGJOO. Final clinical diagnoses and treatment response were extracted from chart review...
February 27, 2019: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Andrew Leopold, Daohai Yu, Rajiv Bhuta, Rahul Kataria, Xiaoning Lu, Asad Jehangir, Martha Harrison, Frank Friedenberg, Zubair Malik, Ron Schey, Henry P Parkman
BACKGROUND: Multiple rapid swallows (MRS) during HREM assess post-deglutitive inhibition, LES relaxation, and subsequent esophageal contraction. AIMS: (1) To determine the relationship between MRS and single-swallow (SS) responses and (2) to determine if MRS provides information for symptomatic patients. METHODS: Healthy volunteers (HVs) and patients underwent HREM [30-s landmark, ten 5-mL SS, MRS (5 consecutive 2-mL swallows every 2-3 s)] and were analyzed with ManoView software version 3 with CC version 3...
February 25, 2019: Digestive Diseases and Sciences
Mohamed H G Khalaf, Sejal Chowdhary, B Joseph Elmunzer, Puja Sukhwani Elias, Donald Castell
BACKGROUND: Due to its smooth muscle relaxing properties, peppermint oil (PO) may relieve dysphagia and chest pain due to esophageal motility disorders. AIM: To explore the impact of PO on dysphagia and/or chest pain in patients referred for motility testing. METHODS: Patients initiated on PO for dysphagia and/or chest pain from 2013 to 2016 were identified. We excluded patients with obstructing esophageal lesions, patients lost to follow-up, and those with preexisting cardiac conditions...
February 15, 2019: Digestive Diseases and Sciences
Joseph R Triggs, Dustin A Carlson, Claire Beveridge, Anand Jain, Michael Y Tye, Peter J Kahrilas, John E Pandolfino
BACKGROUND & AIMS: Under the Chicago Classification of esophageal motility disorders, esophagogastric junction outflow obstruction (EGJOO) includes a varied clinical spectrum that results in diagnostic and management difficulties. We aimed to demonstrate that including upright swallows during high-resolution manometry (HRM) helps identify patients with clinically significant EGJOO. METHODS: We performed a retrospective study of consecutive patients diagnosed with EGJOO on HRM from January 2015 through July 2017...
January 29, 2019: Clinical Gastroenterology and Hepatology
Salih Samo, Emad Qayed
Esophagogastric junction outflow obstruction (EGJOO) is a major motility disorder based on the Chicago Classification of esophageal motility disorders. This entity involves a heterogenous group of underlying etiologies. The diagnosis is reached by performing high-resolution manometry. This reveals evidence of obstruction at the esophagogastric junction, manifested by an elevated integrated relaxation pressure (IRP) above a cutoff value (IRP threshold varies by the manometric technology and catheter used), with preserved peristalsis...
January 28, 2019: World Journal of Gastroenterology: WJG
Byeong Geun Song, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim
Background/Aims: Esophagogastric junction outflow obstruction (EGJOO) is a diagnostically heterogeneous group with variable clinical relevance. We studied whether evaluation of bolus transit by multichannel intraluminal impedance (MII) is useful for discriminating clinically relevant EGJOO. Methods: A total 169 patients diagnosed as having EGJOO between June 2011 and February 2018 were analyzed. All the patients received a combined MII and high-resolution manometry (CMII-HRM)...
January 31, 2019: Journal of Neurogastroenterology and Motility
Stephanie Garbarino, Megan von Isenburg, Deborah A Fisher, David A Leiman
GOALS: Awareness of functional esophagogastric junction outflow obstruction (fEGJOO) has increased, but because there is no consensus on its management, we performed a systematic review of the literature to explore treatment strategies and outcomes. BACKGROUND: EGJOO is a heterogenous disorder defined by high-resolution manometry parameters of elevated integrated relaxation pressure with preserved esophageal peristalsis. The etiology may be mechanical obstruction or idiopathic, the latter being fEGJOO...
December 19, 2018: Journal of Clinical Gastroenterology
Steven B Clayton, Claire M Shin, Alex Ewing, Wojciech Blonski, Joel Richter
BACKGROUND AND AIMS: Idiopathic Esophago-gastric outflow obstruction (EGJOO) is a new clinical entity resulting in delayed esophageal emptying secondary to a poorly relaxing lower esophageal sphincter. Little is known about treatment outcomes of idiopathic EGJOO patients. The aim of this study was to investigate the clinical response of pneumatic dilation (PD) in idiopathic EGJOO patients with a standing barium column and/or with pill arrest on timed barium esophagram (TBE) before and after undergoing PD...
December 10, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Maartje J Singendonk, Zhiyue Lin, Charlotte Scheerens, Jan Tack, Dustin A Carlson, Taher I Omari, John E Pandolfino, Nathalie Rommel
BACKGROUND: High-resolution impedance manometry (HRIM) allows evaluation of esophageal bolus retention, flow, and pressurization. We explored novel HRIM measures and assessed their temporal relationship to dysphagia symptoms for boluses of different volume and consistency in non-obstructive dysphagia (NOD) patients. METHODS: Thirty-three NOD patients (n = 19 minor or no disorder of peristalsis ("Normal") and n = 14 esophagogastric junction outflow obstruction ("EGJOO")) were evaluated with HRIM...
February 2019: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Jessica L Sterling, Ron Schey, Zubair Malik
PURPOSE OF REVIEW: The advancement of high-resolution esophageal manometry has led to improvement in the diagnosis of esophageal motility disorders. We reviewed the recent medical literature regarding the use of botulinum toxin (BTx) injections in the esophagus and the indications, current outcomes, and reported complications of this therapy. RECENT FINDINGS: The response rates of BTx injection therapy vary depending on the esophageal motility disorder. Studies have shown that response is transient in achalasia patients and given the more effective therapies available, it is only recommended in patients who are not surgical candidates...
December 2018: Current Treatment Options in Gastroenterology
Mouen A Khashab, Pietro Familiari, Peter V Draganov, Hanaa Dakour Aridi, Joo Young Cho, Michael Ujiki, Ricardo Rio Tinto, Hubert Louis, Pankaj N Desai, Vic Velanovich, Eduardo Albéniz, Amyn Haji, Jeffrey Marks, Guido Costamagna, Jacques Devière, Yaseen Perbtani, Mason Hedberg, Fermin Estremera, Luis A Martin Del Campo, Dennis Yang, Majidah Bukhari, Olaya Brewer, Omid Sanaei, Lea Fayad, Amol Agarwal, Vivek Kumbhari, Yen-I Chen
Background and study aims : The efficacy of per oral endoscopic myotomy (POEM) in non-achalasia esophageal motility disorders such as esophagogastric junction outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and jackhammer esophagus (JE) has not been well demonstrated. The aim of this international multicenter study was to assess clinical outcomes of POEM in patients with non-achalasia disorders, namely DES, JE, and EGJOO, in a large cohort of patients. Patients and methods : This was a retrospective study at 11 centers...
August 2018: Endoscopy International Open
George Triadafilopoulos, John O Clarke
Background: The Chicago Classification (CC) defines oesophagogastric junction outflow obstruction (EGJOO) as the presence of an elevated integrated residual pressure (IRP) together with preserved oesophageal body peristalsis but its clinical significance is evolving. Aims: To describe the clinical and manometric characteristics in patients with EGJOO and propose a new classification. Methods: In this retrospective cohort study, patients with functional oesophageal symptoms underwent clinical and endoscopic assessment and oesophageal high-resolution manometry (HRM)...
2018: BMJ Open Gastroenterology
Keita Fukaura, Eikichi Ihara, Haruei Ogino, Yoichiro Iboshi, Kazumasa Muta, Bai Xiaopeng, Shohei Hamada, Yoshitaka Hata, Tsutomu Iwasa, Akira Aso, Kazuhiko Nakamura, Yoshihiro Ogawa
BACKGROUND AND AIM: Although basic research has shown that certain cytokines affect gastrointestinal motility, the clinical evidence is lacking. The objective of this study was to explore the association between mucosally expressed cytokines and the esophageal motility function in humans. METHODS: We enrolled a total of 57 patients with suspected esophageal motility disorders (EMDs) who underwent high-resolution manometry. RESULTS: The diagnoses of the patients were as follows: normal esophageal motility (n = 25), ineffective esophageal motility (n = 5), esophagogastric junction outflow obstruction (EGJOO; n = 10), distal esophageal spasm (n = 5), achalasia (n = 10), absent contractility (n = 1), and jackhammer esophagus (n = 1)...
2018: Digestion
Andrew Ming Liang Ong, Vikneswaran Namasivayam, Yu Tien Wang
BACKGROUND AND AIM: Esophagogastric junction outflow obstruction (EGJOO) may be due to anatomical abnormalities, but it is unclear how to evaluate them after high-resolution manometry. We aimed to determine (i) clinical and high-resolution manometry parameters differentiating anatomical EGJOO from functional EGJOO, (ii) investigations chosen and yield for anatomical EGJOO, and (iii) clinical outcomes of functional EGJOO. METHODS: Medical records of consecutive patients with symptomatic EGJOO from February 2012 to December 2015 were reviewed...
October 2018: Journal of Gastroenterology and Hepatology
A Tangaroonsanti, M F Vela, M D Crowell, K R DeVault, L A Houghton
BACKGROUND: Proximal reflux and incomplete transit of boluses swallowed are risk factors for obstructive chronic lung allograft dysfunction (o-CLAD) post-lung transplantation (LTx). Likewise, so is esophagogastric junction outflow obstruction (EGJOO), but not hypo-contractility, when diagnosed using Chicago Classification (CC) v3.0. Given, peristaltic breaks as defined using CCv2.0 can prolong esophageal clearance, both swallowed and refluxed, but which are deemed within normality using CCv3...
June 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
B G Song, Y W Min, H Lee, B-H Min, J H Lee, P-L Rhee, J J Kim
BACKGROUND: Integrated relaxation pressure (IRP) is a key metric for diagnosing esophagogastric junction outflow obstruction (EGJOO). However, its normal value might be different according to the manufacturer of high-resolution manometry (HRM). This study aimed to investigate optimal value of IRP for diagnosing EGJOO in Sandhill HRM and to find clinicomanometric variables to segregate clinically relevant EGJOO. METHODS: We analyzed 262 consecutive subjects who underwent HRM between June 2011 and December 2016 showing elevated median IRP (> 15 mm Hg) but did not satisfy criteria for achalasia...
March 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
P Blais, A Patel, G S Sayuk, C P Gyawali
BACKGROUND: The upper esophageal sphincter (UES) reflexively responds to bolus presence within the esophageal lumen, therefore UES metrics can vary in achalasia. METHODS: Within consecutive patients undergoing esophageal high-resolution manometry (HRM), 302 patients (58.2±1.0 year, 57% F) with esophageal outflow obstruction were identified, and compared to 16 asymptomatic controls (27.7±0.7 year, 56% F). Esophageal outflow obstruction was segregated into achalasia subtypes 1, 2, and 3, and esophagogastric junction outflow obstruction (EGJOO with intact peristalsis) using Chicago Classification v3...
December 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
D Schupack, D A Katzka, D M Geno, K Ravi
BACKGROUND: Although major manometric abnormalities, the significance of esophagogastric junction outflow obstruction (EGJOO) and hypercontractile esophagus (HE) is poorly understood. We sought to determine long term outcomes for EGJOO and HE. METHODS: High-resolution impedance manometry (HRIM) studies conducted from 5/30/2012 to 8/1/2014 consistent with EGJOO and HE and normal studies from 5/30/12 to 11/1/12 were identified. Standardized follow up was conducted with a phone survey utilizing the impact dysphagia questionnaire (IDQ-10)...
October 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
A Jain, J R Baker, J H Rubenstein, J W Chen
BACKGROUND: A manometric diagnosis of esophagogastric junction outflow obstruction (EGJOO) without a mechanical cause creates a therapeutic conundrum. The aim of this study was to assess esophageal bolus clearance in EGJOO and assess manometric factors associated with clearance in EGJOO. METHODS: Bolus clearance was assessed using line-tracing method and contour method to determine Complete Bolus Transit (CBT) and Functional Clearance (FC), respectively, on combined High-Resolution Impedance Manometry (HRIM)...
September 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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