Tu1396 BOLUS TRANSIT IN ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION (EGJOO) WITH OR WITHOUT ESOPHAGEAL BODY DYSMOTILITY: A MULTICENTER ANALYSIS

Abstract Background Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment. Methods A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations. Results Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03. Conclusion This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.

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EGJ Outflow Obstruction is Often Associated with Coexistent Abnormal Esophageal Body Motility and Abnormal Bolus Transit

Gastroenterology ◽

10.1016/s0016-5085(17)31362-8 ◽

2017 ◽

Vol 152 (5) ◽

pp. S326 ◽

Cited By ~ 1

Author(s):

Elizabeth Zheng ◽

Joshua Sloan ◽

R. Matthew Gideon ◽

Philip Katz

Keyword(s):

Outflow Obstruction ◽

Bolus Transit ◽

Esophageal Body ◽

Body Motility ◽

Esophageal Body Motility

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Assessment of Esophageal High-Resolution Impedance Manometry in Patients with Nonobstructive Dysphagia

Gastroenterology Research and Practice ◽

10.1155/2018/6272515 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Zhaoyu Liu ◽

Jiazhi Liao ◽

Dean Tian ◽

Mei Liu ◽

Zili Dan ◽

...

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

Esophagogastric Junction ◽

Esophageal Motility Disorders ◽

Outflow Obstruction ◽

Esophageal Motility Disorder ◽

Bolus Transit ◽

Motility Disorders ◽

Esophageal Transit ◽

Clinical Diagnoses

Background. High-resolution impedance manometry (HRIM) can calculate the bolus motion parameters and the ratio of complete esophageal transit besides the conventional esophageal dynamic parameters; therefore, we could better manage the patients with nonobstructive dysphagia (NOD) clinically. Aim. To analyze the HRIM parameter results of NOD patients and evaluate the characteristics of their esophageal motility and transit function. Methods. In total, 58 NOD patients were assessed and the clinical diagnoses were determined. HRIM was performed, and both conventional high-resolution manometry and esophageal transit parameters were analyzed. Results. In 58 NOD patients, 28 patients had achalasia, 3 esophagogastric junction outflow obstruction, and 20 nonspecific esophageal motility disorders, and 7 were normal. Impedance results demonstrated that all the patients with achalasia exhibited incomplete esophageal transit (ICET), three patients with esophagogastric junction outflow obstruction showed ICET, and the average bolus transit time (BTT) was 6.6 ± 1.2 sec. In 20 nonspecific esophageal motility disorders, 13 patients with gastroenterologly reflux disease (GERD) presented ineffective esophageal motility and fragmented peristalsis, and 65.0% swallows had exhibited ICET. However, 49.1% swallows of 7 nonspecific esophageal motility disorder patients with non-GERD had exhibited ICET. The average BTT in 13 GERD patients was longer than that in the non-GERD patients (8.1 ± 1.1 sec versus 5.5 ± 0.3 sec, P<0.05). And in the seven patients with normal esophagus function, 3.5% swallows showed ICET and BTT was 5.6 ± 0.3 sec. Conclusion. Achalasia was the most common esophageal dysmotility in NOD patients, followed by nonspecific esophageal motility disorders. The clinical diagnoses of NOD were mostly achalasia and GERD. Impedance assessments showed that all achalasia cases exhibited ICET, and other esophageal motility abnormalities that represented ICET were associated with contraction break and ineffective swallow. Compared to non-GERD patients, BTT was significantly prolonged in patients with GERD.

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Sa1351 Baseline Esophagogastric Junction Metrics and Dynamic Esophageal Body Contraction Changes on Provocative Testing Differentiate Etiologies of Esophagogastric Junction Outflow Obstruction (EGJOO)

Gastroenterology ◽

10.1016/s0016-5085(16)31022-8 ◽

2016 ◽

Vol 150 (4) ◽

pp. S293 ◽

Cited By ~ 1

Author(s):

Michael Bennett ◽

Amit Patel ◽

Dan Wang ◽

Alexandra Guillaume ◽

Rubin Bahuva ◽

...

Keyword(s):

Esophagogastric Junction ◽

Outflow Obstruction ◽

Esophageal Body ◽

Provocative Testing

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416 Esophageal Body Dysfunction in Patients With Esophagogastric Junction Outflow Obstruction: A Potential Flaw in the Chicago Classification

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000591196.56682.e3 ◽

2019 ◽

Vol 114 (1) ◽

pp. S244-S244

Author(s):

Kenneth DeVault ◽

Ramsah Cheah ◽

Supphamat Chirnaksorn ◽

Dawn Francis ◽

Ernest Bouras ◽

...

Keyword(s):

Esophagogastric Junction ◽

Outflow Obstruction ◽

Esophageal Body ◽

Chicago Classification

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Response to multiple rapid swallows shows impaired inhibitory pathways in distal esophageal spasm patients with and without concomitant esophagogastric junction outflow obstruction

Diseases of the Esophagus ◽

10.1093/dote/doaa048 ◽

2020 ◽

Vol 33 (10) ◽

Author(s):

Patricia V Hernandez ◽

Luis R Valdovinos ◽

Jennifer L Horsley-Silva ◽

Miguel A Valdovinos ◽

Michael D Crowell ◽

...

Keyword(s):

Esophagogastric Junction ◽

Botulinum Toxin Injection ◽

Pneumatic Dilation ◽

Outflow Obstruction ◽

Esophageal Body ◽

Esophageal Spasm ◽

Inhibitory Pathways ◽

Healthy Control ◽

Endoscopic Myotomy ◽

Integrated Relaxation Pressure

Summary Distal esophageal spasm (DES) is a motility disorder characterized by premature contraction of the esophageal body during single swallows. It is thought to be due to impairment of esophageal inhibitory pathways, but studies to support this are limited. The normal response to multiple rapid swallows (MRS) is deglutitive inhibition of the esophageal body during the MRS sequence. Our aim was to compare the response to MRS in DES patients and healthy control subjects. Response to MRS during HRM was evaluated in 19 DES patients (8 with and 11 without concomitant esophagogastric junction outflow obstruction [EGJOO]) and 24 asymptomatic healthy controls. Patients with prior gastroesophageal surgery, peroral endoscopic myotomy, pneumatic dilation, esophageal botulinum toxin injection within 6 months of HRM, opioid medication use, and esophageal stricture were excluded. Response to MRS was evaluated for complete versus impaired inhibition (esophageal body contractility with distal contractile integral [DCI] > 100 mmHg-sec-cm during MRS), presence of post-MRS contraction augmentation (DCI post MRS greater than single swallow mean DCI), and integrated relaxation pressure (IRP). Impaired deglutitive inhibition during MRS was significantly more frequent in DES compared to controls (89% vs. 0%, P < 0.001), and frequency was similar for DES with versus without concomitant EGJOO (100% vs. 82%, P = 0.48). The proportion of subjects with augmentation post MRS was similar for both groups (37% vs. 38%, P = 1.00), but mean DCI post MRS was higher in DES than controls (3360.0 vs. 1238.9, P = 0.009). IRP was lower during MRS compared to single swallows in all patients, and IRP during MRS was normal in 5 of 8 patients with DES and EGJOO. Our study suggests that impaired deglutitive inhibition during MRS is present in the majority of patients with DES regardless of whether they have concomitant EGJOO, and future studies should explore the usefulness of incorporating response to MRS in the diagnosis of DES.

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