TY - JOUR
T1 - The conundrum of esophagogastric junction outflow obstruction
T2 - Answers to key clinical questions
AU - Lynch, Kristle Lee
AU - Gyawali, C. Prakash
AU - Coss-Adame, Enrique
AU - Siboni, Stefano
AU - Vélez, Christopher
AU - Khan, Abraham
AU - Visaggi, Pierfrancesco
AU - Sloan, Joshua A.
AU - Gavini, Sravanya
AU - Sozzi, Marco
AU - Wu, Justin
N1 - Publisher Copyright:
© 2025 The Author(s). Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of The New York Academy of Sciences.
PY - 2025/7
Y1 - 2025/7
N2 - Esophagogastric junction outflow obstruction (EGJOO) is a heterogeneous disorder characterized by abnormal esophagogastric junction residual pressures in the setting of intact esophageal body peristalsis. This manometric finding is most clinically relevant in patients with dysphagia and chest pain, and may arise from various mechanisms, including structural processes, catheter positioning artifact, and medications. Rarely, manometric EGJOO is a consequence of abnormal relaxation of the lower esophageal sphincter (LES) akin to achalasia. Thus, it is critical in the evaluation of EGJOO to determine if a true pressure gradient exists across the esophagogastric junction (EGJ) that warrants therapy. There are many unanswered questions in EGJOO diagnosis and management, which are addressed in this review in the context of the use of provocative maneuvers during high-resolution manometry, complementary and alternate testing, and therapeutic options.
AB - Esophagogastric junction outflow obstruction (EGJOO) is a heterogeneous disorder characterized by abnormal esophagogastric junction residual pressures in the setting of intact esophageal body peristalsis. This manometric finding is most clinically relevant in patients with dysphagia and chest pain, and may arise from various mechanisms, including structural processes, catheter positioning artifact, and medications. Rarely, manometric EGJOO is a consequence of abnormal relaxation of the lower esophageal sphincter (LES) akin to achalasia. Thus, it is critical in the evaluation of EGJOO to determine if a true pressure gradient exists across the esophagogastric junction (EGJ) that warrants therapy. There are many unanswered questions in EGJOO diagnosis and management, which are addressed in this review in the context of the use of provocative maneuvers during high-resolution manometry, complementary and alternate testing, and therapeutic options.
KW - Chicago classification
KW - chest pain
KW - dysphagia
KW - esophageal dysmotility
KW - esophagogastric junction outflow obstruction
KW - hiatal hernia
KW - timed barium esophagram
UR - https://www.scopus.com/pages/publications/105006986009
U2 - 10.1111/nyas.15362
DO - 10.1111/nyas.15362
M3 - Comment/debate
C2 - 40452117
AN - SCOPUS:105006986009
SN - 0077-8923
VL - 1549
SP - 5
EP - 10
JO - Annals of the New York Academy of Sciences
JF - Annals of the New York Academy of Sciences
IS - 1
ER -