Esophagogastric Junction Outflow Obstruction
| Autor: | Sumeet K. Mittal, R. Bremner, Mate Csucska, Takahiro Masuda |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Manometry Achalasia 03 medical and health sciences 0302 clinical medicine Internal medicine Statistical significance otorhinolaryngologic diseases medicine Humans Esophageal Motility Disorders Clinical significance In patient Esophagogastric junction Retrospective Studies Peristalsis business.industry Gastroenterology medicine.disease Dysphagia Esophageal Achalasia 030220 oncology & carcinogenesis Mann–Whitney U test Cardiology 030211 gastroenterology & hepatology Esophagogastric Junction medicine.symptom business |
| Zdroj: | Journal of Clinical Gastroenterology. 55:121-126 |
| ISSN: | 0192-0790 |
| DOI: | 10.1097/mcg.0000000000001355 |
| Popis: | Goals The authors aimed to compare preperistaltic distal esophageal pressure in patients with esophagogastric junction outflow obstruction (EGJOO) with and without reported dysphagia. Background Manometric EGJOO is characterized by elevated integral relaxation pressure (>15 mm Hg) without achalasia. The nomenclature inherently implies that it should be associated with impaired food bolus transit and should theoretically present clinically as dysphagia. Study The authors queried an esophageal functional test database to identify patients diagnosed with EGJOO. They excluded patients who presented with ≥2 swallows with abnormal (ie, weak, failed or hypercontractile) esophageal body motility. To elucidate differences in manometric findings, the authors formed 2 cohorts of patients on the basis of a standard esophageal symptom questionnaire: those without dysphagia and those with severe or very severe dysphagia. All studies were reanalyzed to determine the distal esophageal pressure before each peristaltic wave (ie, the preperistaltic pressure) for individual swallows. The Mann-Whitney U test was used to compare categorical variables between groups. The level of significance was set to P Results In total, 149 patients were diagnosed with EGJOO during the study period. Of these, 42 patients with ≥9 (out of 10) peristalsis (20 without dysphagia and 22 with severe/very severe dysphagia) formed the study cohorts. Patients with severe dysphagia had significantly higher median preperistaltic pressures in the distal esophagus. Preperistaltic pressure measurements showed better sensitivity and specificity for dysphagia than integral relaxation pressure. Conclusions Elevated preperistaltic pressure is noted in symptomatic EGJOO patients. Inclusion of preperistaltic pressure in the diagnostic criteria for EGJOO may increase the clinical relevance of manometric classification. |
| Databáze: | OpenAIRE |
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