title: What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center.
abstract: BACKGROUND
  Esophagogastric junction (EGJ) outflow obstruction (EGJOO) is characterized by impaired EGJ relaxation with intact or weak peristalsis. Our aims were to evaluate: (i) prevalence, (ii) yield of fluoroscopy, endoscopy, and endoscopic ultrasound (EUS), (iii) outcomes, and (iv) whether this data differed based on quantitative EGJ relaxation.
  
  
  METHODS
  Studies that met criteria for EGJOO were identified. Demographics, encounters, endoscopy, radiology, treatment decisions, and outcomes were extracted.
  
  
  RESULTS
  Sixty studies were identified. Dysphagia was the most common symptom. Forty patients underwent barium esophagram (BE): normal (11), hiatal hernia (20), spasm/dysmotility (17), EGJ narrowing (10), compression (2), Schatzki's ring (5), malrotation (1), gastric volvulus (1), mass (1). Esophagogastroduodenoscopy (EGD) was performed in 41 patients: normal (19), hiatal hernia (13), Schatzki's ring (6), esophagitis (3), esophageal candidiasis (3), mass (1). EUS was performed in 20 patients and was frequently normal. Twenty-two patients underwent intervention. While transient improvement was noted in the majority, persistent improvement was seen in only one of nine patients (dilatation), four of six patients (botulinum toxin), and three patients who underwent per-oral endoscopic myotomy. No patients treated with medical therapy alone had improvement in dysphagia. There was no difference in symptoms or outcomes based on quantitative EGJ relaxation.
  
  
  CONCLUSIONS
  The manometric criterion EGJOO defines a heterogeneous clinical group. While BE, EGD, and EUS all provide complementary information, a significant percentage of these studies will be normal. For patients with dysphagia, outcome may depend on EGJ disruption. There were no differences in symptoms our outcomes based on quantitative EGJ relaxation.
authors.affiliation: Division of Hospital Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: F C
authors.initials: FC
authors.lastname: Okeke
authors.affiliation: Division of Gastroenterology & Hepatology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Raja
authors.affiliation: Division of Gastroenterology & Hepatology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Lynch
authors.affiliation: Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Dhalla
authors.affiliation: Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Nandwani
authors.affiliation: Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Stein
authors.affiliation: Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: B
authors.initials: B
authors.lastname: Chander Roland
authors.affiliation: Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Division of Gastroenterology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Saxena
authors.affiliation: Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: V
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Division of Gastroenterology & Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: N K
authors.initials: NK
authors.lastname: Ahuja
authors.affiliation: Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: J O
authors.identifier: http://orcid.org/0000-0003-2625-1169
authors.initials: JO
authors.lastname: Clarke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004935:Esophageal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: dysphagia; esophagogastric outflow obstruction (EGJOO); high-resolution esophageal pressure topography (HREPT)