Obstrucción del tracto de salida de la unión esofagogástrica: ¿Qué es y cómo manejarla?

The motor esophageal disorders are categorized according to the Chicago Classification 3.0 into major and minor disorders of peristalsis; and those with outflow obstruction; divided in achalasia and esophagogastric junction outflow obstruction (EGJOO). The present study has as an objective to revise the types of EGJOO, their etiology, clinical manifestations, pathophysiology, diagnostic tests and different treatment options. EGJOO comprises a heterogeneous group of patients characterized by manometric findings of an alteration in the EGJ, with the presence of intact or weak peristalsis of the esophageal body, in such a way that the criteria for achalasia are not met. It can be caused not only by functional pathology (idiopathic) but structural (secondary) pathology. Dysphagia is the most common symptom, followed by chest pain, regurgitation and heartburn. The finding of EGJOO in the absence of secondary etiology is accompanied by clinical uncertainty. Some seem to have an early stage of achalasia, while others have almost no obstructive symptoms and the finding of a high integrated relaxation pressure may be only an incidental finding without clinical implication or relevance. Differentiating secondary EGJOO is important because these patients will require a different management on many occasions compared to patients with primary or idiopathic EGJOO. Within the diagnostic armamentarium, we count with endoscopy, esophagogram and high-resolution manometry to identify underlying causes of incomplete relaxation of the EGJ. Endoscopic ultrasound and computed tomography can help us exclude infiltrative or inflammatory pathology. Although there are no curative treatments for EGJOO disorders, there are options for medical, endoscopic and surgical management. Individualized management of this condition is recommended, taking into account factors such as the symptoms of the patient and the severity of these symptoms, and the type of EGJOO (functional vs. structural), among others, remembering that in a significant percentage of patients there might be a spontaneous resolution of symptoms during follow-up.