title: Functional and Anatomic Esophagogastic Junction Outflow Obstruction: Manometry, Timed Barium Esophagram Findings, and Treatment Outcomes.
abstract: Little is known about the clinical features, radiology and manometry findings, and treatment outcomes of patients with functional and mechanical esophagogastic junction outflow obstruction (EGJOO). Between November 2011 and February 2015, a total of 1443 high-resolution manometries were reviewed and 49 patients (3.4%) met the manometric criteria for EGJOO. Then, we performed a retrospective chart review, collecting data from manometric studies, timed barium esophagram findings (TBEs), endoscopic reports, and clinical records. Twenty-seven patients had functional EGJOO and 22 patients had an anatomic esophageal obstruction. Common causes of anatomic EGJOO included strictures (36% of patients) and hiatal hernias (31% of patients). There were no differences between groups in manometric or radiographic metrics. Each group had increased basal lower esophageal sphincter and intrabolus pressures, compared with individuals without EGJOO, and most patients had abnormal findings on TBE analysis. Two patients with functional EGJOO progressed to type 3 achalasia. We conclude that patients diagnosed with EGJOO based on manometry findings can have anatomic obstruction or functional EGJOO; high-resolution manometry and TBE do not distinguish between disease causes.
authors.affiliation: University of South Carolina School of Medicine, Greenville, Greenville Health System Gastroenterology and Liver Center, Greenville, South Carolina. Electronic address: zsbc10@gmail.com.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Clayton
authors.affiliation: Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida.
authors.forename: Rupal
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Richter
mesh_terms: D000368:Aged; D001464:Barium / Q000008:administration & dosage; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001464:Barium
keywords: Dysphagia; EGJOO; HRM; High-Resolution Manometry; Timed Barium Swallow