Esophagogastric Junction Outflow Obstruction (EGJOO): A Manometric Phenomenon or Clinically Impactful Problem.

Q1 Medicine Current Gastroenterology Reports Pub Date : 2024-07-01 Epub Date: 2024-03-28 DOI:10.1007/s11894-024-00928-6

Laura Bach, Marcelo F Vela

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Abstract

Purpose of review: Esophagogastric junction outflow obstruction (EGJOO), defined manometrically by impaired esophagogastric junction relaxation (EGJ) with preserved peristalsis, can be artifactual, due to secondary etiologies (mechanical, medication-induced), or a true motility disorder. The purpose of this review is to go over the evolving approach to diagnosing and treating clinically relevant EGJOO.

Recent findings: Timed barium esophagram (TBE) and the functional lumen imaging probe (FLIP) are useful to identify clinically relevant EGJOO that merits lower esophageal sphincter (LES) directed therapies. There are no randomized controlled trials evaluating EJGOO treatment. Uncontrolled trials show effectiveness for pneumatic dilation and peroral endoscopic myotomy to treat confirmed EGJOO; Botox and Heller myotomy may also be considered but data for confirmed EGJOO is more limited. Diagnosis of clinically relevant idiopathic EGJOO requires symptoms, exclusion of mechanical and medication-related etiologies, and confirmation of EGJ obstruction by TBE or FLIP. Botox LES injection has limited durability, it can be used in patients who are not candidates for other treatments. PD and POEM are effective in confirmed EGJOO, Heller myotomy may also be considered but data for confirmed EGJOO is limited. Randomized controlled trials are needed to clarify optimal management of EGJOO.

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食管胃交界流出道梗阻 (EGJOO)：是人体测量现象还是有临床影响的问题？

审查目的：食管胃交界处流出道梗阻（EGJOO）是指食管胃交界处松弛功能（EGJ）受损而蠕动功能保持不变，根据压力计定义，这种梗阻可能是人为的，也可能是继发性病因（机械性、药物引起的）或真正的运动障碍。本综述旨在介绍诊断和治疗临床相关 EGJOO 的不断发展的方法：定时食管钡餐造影（TBE）和功能性管腔成像探针（FLIP）有助于识别临床相关的 EGJOO，这些 EGJOO 值得采用下食管括约肌（LES）导向疗法。目前还没有评估 EJGOO 治疗的随机对照试验。非对照试验显示，气压扩张和口腔内窥镜肌切开术对治疗确诊的 EGJOO 有效；肉毒杆菌毒素和海勒肌切开术也可考虑，但用于确诊的 EGJOO 的数据较为有限。诊断临床相关的特发性 EGJOO 需要症状、排除机械和药物相关病因，并通过 TBE 或 FLIP 确认 EGJ 阻塞。肉毒杆菌毒素 LES 注射的持久性有限，但可用于不适合接受其他治疗的患者。PD和POEM对确诊的EGJOO有效，也可考虑进行海勒肌切开术，但确诊的EGJOO数据有限。需要进行随机对照试验，以明确 EGJOO 的最佳治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Gastroenterology Reports Medicine-Gastroenterology

CiteScore

7.80

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0.00%

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期刊介绍： As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.

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