Journal ArticleDOI
Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry
M.-T. Pérez-Fernández,Cecilio Santander,Almudena Marinero,D. Burgos-Santamaría,Carlos Miguel Chavarría-Herbozo +4 more
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TLDR
The objective was to increase the awareness of EGJOO to optimize the management of patients with Esophagogastric junction outflow obstruction.Abstract:
Background
Esophagogastric junction outflow obstruction (EGJOO) is a newly described diagnostic entity growing in importance due to the use of high resolution manometry (HRM). There is little knowledge regarding its incidence, etiopathogeny, long-term evolution, and most suitable treatment. Our objective was to increase the awareness of EGJOO to optimize the management of these patients.
Methods
We conducted a historical (retrospective and prospective) study of patients diagnosed with EGJOO using HRM combined with multichannel intraluminal impedance, comparing their manometric and impedance characteristics with those of a control group. Symptoms, etiology of obstruction, acid exposure, clinical course (and its associated factors), and response to treatment were also evaluated in the EGJOO group.
Key Results
Forty-four subjects were included (28 patients and 16 controls). Esophagogastric junction outflow obstruction patients presented incomplete esophageal transit more frequently than controls. Patients with structural obstruction had dysphagia more frequently than patients with functional obstruction, and different manometric, impedance, and pH-metric patterns. Over one-third of the EGJOO patients presented a spontaneous resolution of symptoms without EGJOO treatment. In the multivariate analysis, the variables associated with this spontaneous symptomatic resolution included typical symptoms of gastro-esophageal reflux disease or epigastralgia as the main symptom and resting or basal pressure of the upper esophageal sphincter <50 mmHg.
Conclusions & Inferences
The majority of EGJOO patients presented intact peristalsis which may compensate for the lack of EGJ relaxation. In the EGJOO patients presenting favorable factors associated with a spontaneous resolution of symptoms, invasive treatments should be considered with special caution. Structural etiologies are more amenable to management, while the remainder may improve without intervention.read more
Citations
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Journal ArticleDOI
Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©
Rena Yadlapati,Peter J. Kahrilas,Mark A. Fox,Albert J. Bredenoord,C. Prakash Gyawali,Sabine Roman,Arash Babaei,Ravinder K. Mittal,Ravinder K. Mittal,Nathalie Rommel,Edoardo Savarino,Daniel Sifrim,André J.P.M. Smout,Michael F. Vaezi,Frank Zerbib,Junichi Akiyama,Shobna Bhatia,Serhat Bor,Dustin A. Carlson,Joan W. Chen,Daniel Cisternas,Charles Cock,Enrique Coss-Adame,Nicola de Bortoli,C Defilippi,Ronnie Fass,Uday C Ghoshal,Sutep Gonlachanvit,Albis Hani,Geoffrey S. Hebbard,Kee Wook Jung,Philip O. Katz,David A. Katzka,Abraham Khan,Geoffrey P. Kohn,Adriana Lazarescu,Johannes Lengliner,Sumeet K. Mittal,Taher Omari,Moo In Park,Roberto Penagini,Daniel Pohl,Joel E. Richter,Jordi Serra,Rami Sweis,Jan Tack,Roger P. Tatum,Radu Tutuian,Radu Tutuian,Marcelo F. Vela,Reuben K. Wong,Justin C.Y. Wu,Yinglian Xiao,John E. Pandolfino +53 more
TL;DR: The Chicago Classification v4.4.0 as discussed by the authors is the most recent version of the Chicago Classification, which uses high-resolution manometry (HRM) for motility disorders.
Journal ArticleDOI
Evaluation of Esophageal Motility Utilizing the Functional Lumen Imaging Probe.
Dustin A. Carlson,Peter J. Kahrilas,Zhiyue Lin,Ikuo Hirano,Nirmala Gonsalves,Zoe Listernick,Katherine A. Ritter,Michael Y. Tye,Fraukje A. Ponds,Ian Wong,John E. Pandolfino +10 more
TL;DR: FLIP topography provides an alternative and complementary method to HRM for evaluation of non-obstructive dysphagia and may indicate otherwise undetected abnormalities of esophageal function, thus FLIP provides a well-tolerated method for esphageal motility assessment at the time of upper endoscopy.
Journal ArticleDOI
Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders.
Ezra N. Teitelbaum,Christy M. Dunst,Kevin M. Reavis,Ahmed Sharata,Marc A. Ward,Steven R. DeMeester,Lee L. Swanstrom +6 more
TL;DR: POEM resulted in a successful palliation of symptoms in the majority of patients after 5 years, though these results emphasize the importance of long-term follow-up in all patients.
Journal ArticleDOI
Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute
TL;DR: In this paper, the authors describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia, based on expert opinion and on relevant publications from PubMed and EMbase.
Journal ArticleDOI
The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry.
TL;DR: Long term outcomes for EGJOO and HE are determined by determining long term outcomes of major manometric abnormalities in esophagogastric junction outflow obstruction and hypercontractile esophagus.
References
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Journal ArticleDOI
The Chicago Classification of esophageal motility disorders, v3.0.
Peter J. Kahrilas,Albert J. Bredenoord,Mark A. Fox,C P Gyawali,Sabine Roman,A J P M Smout,John E. Pandolfino +6 more
TL;DR: The Chicago Classification (CC) of esophageal motility disorders, utilizing an algorithmic scheme to analyze clinical high‐resolution manometry (HRM) studies, has gained acceptance worldwide.
Journal Article
Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux.
Johnson Lf,Demeester Tr +1 more
Journal ArticleDOI
Chicago Classification Criteria of Esophageal Motility Disorders Defined in High Resolution Esophageal Pressure Topography
Arjan Bredenoord,Mark A. Fox,Peter J. Kahrilas,John E. Pandolfino,Werner Schwizer,Andreas J. Smout +5 more
TL;DR: The Chicago Classification of esophageal motility has been an evolutionary process, molded first by published evidence pertinent to the clinical interpretation of high resolution manometry (HRM) studies and secondarily by group experience when suitable evidence is lacking.
Journal ArticleDOI
Classification of oesophageal motility abnormalities
Stuart J. Spechler,D O Castell +1 more
TL;DR: Clinicians and researchers can determine if their patients fulfil the manometric criteria for a putative motility disorder by applying the guidelines proposed in this report, which should facilitate and improve comparisons among patients and studies.
Journal ArticleDOI
ACG clinical guideline: diagnosis and management of achalasia
TL;DR: This ACG guideline presents an evidence-based approach in patients with achalasia based on a comprehensive review of the pertinent evidence and examination of relevant published data.