Esophagogastric Junction Outflow Obstruction: A Diagnosis in Evolution

Kristle Lee Lynch; Joan Chen; Anand Jain; Rena Yadlapati

Esophagogastric Junction Outflow Obstruction: A Diagnosis in Evolution

Gastroenterol Hepatol (N Y). 2024 Feb;20(2):108-114.

Authors

Kristle Lee Lynch¹, Joan Chen², Anand Jain³, Rena Yadlapati⁴

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania.
² Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
³ Division of Digestive Diseases, Emory University, Atlanta, Georgia.
⁴ Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California.

PMID: 38414912
PMCID: PMC10895913

Abstract

Esophagogastric junction outflow obstruction (EGJOO) is a rapidly evolving diagnosis that can represent early or variant achalasia. Since the publication of the Chicago Classification version 4.0, the criteria for this diagnosis have been more stringent. Currently, the criteria include an elevated median integrated relaxation pressure (IRP) in both the supine and upright positions, elevated intrabolus pressure in at least 20% of supine swallows, dysphagia and/or chest pain, as well as an abnormal timed barium esophagram and/or impedance planimetry testing. Additionally, other secondary causes may result in an elevated IRP and must be excluded. The management of conclusive EGJOO is targeted therapy to the lower esophageal sphincter (LES), although treatment is not straightforward. Overall, adjuvant testing and data should be scrutinized for appropriateness of LES disruption. The spectrum of treatment options includes simple monitoring as well as more invasive therapies such as endoscopic dilation and myotomy. This article explores the newest criteria and management options for clinically relevant EGJOO.

Keywords: Esophagogastric junction outflow obstruction; achalasia; dysphagia; esophageal dysmotility; esophageal manometry.