Clinical features and esophageal motility characteristics of patients with esophagogastric junction outflow obstruction / 中华消化杂志

Objective To analyze the clinical features and esophageal motility characteristics of patients with esophagogastric junction outflow obstruction (EGJOO).Methods From January 2015 to January 2018,at Affiliated Hospital of Zunyi Medical College,the clinical data of 663 outpatients with various gastrointestinal symptoms were collected.Gastroscopy and esophageal high resolution manometry (HRM) were performed to exclude gastrointestinal organic lesions.The 120 patients were divided into EGJOO group (71 cases) and non-EGJOO group (49 cases).Furthermore,according to integrated relaxation pressure (IRP) the 71 EGJOO patients were divided into mild group (41 cases),moderate group (20 cases) and severe group (10 cases).Independent sample t test and one-way analysis of variance were performed for statistical analysis.Results Among 71 EGJOO patients,43.7％ (31/71) showed post sternal heartburn or acid regurgitation,32.4％ (23/71) showed obstruction or dysphagia,21.1％ (15/71) showed chest pain,21.1％ (15/71) showed other atypical symptoms such as hiccups and bloating,and 5.6％ (4/71) showed upper abdominal pain.The IRP,lower esophageal sphincter (LES) length,LES resting pressure and intrabolus pressure (IBP) of the EGJOO group were higher than those of the non-EGJOO group ((18.24 ± 3.07) mmHg (1 mmHg =0.133 kPa) vs.(10.92 ± 2.37) mmHg,(3.47 ± 0.85) cm vs.(3.11 ±0.80) cm,(32.33 ±9.11) mmHg vs.(21.31 ±6.55) mmHg,(6.22 ±3.74) mmHg vs.(4.69 ± 2.68) mmHg),and the differences were statistically significant (t =-13.947,-2.303,-7.706 and-2.626;all P ＜ 0.05).The LES relaxation rate and distal contractile integral (DCI) of the EGJOO group were lower than those of the non-EGJOO group ((44.03 ±9.86)％ vs.(53.86 ±11.33)％,(1410.13± 794.23) mmHg·s·cm vs.(1 741.86 ±894.16) mmHg · s · cm),and the differences were statistically significant (t =5.046 and 2.136,both P ＜ 0.05).The LES resting pressure of the mild group was higher than that of the moderate group ((30.76 ±9.23) mmHg vs.(29.69 ±5.87) mmHg);the LES resting pressure of the moderate group was lower than that of the severe group ((29.69 ± 5.87) mmHg vs.(42.02 ± 9.23) mmHg);and the differences were statistically significant (both Tamhane test,P =0.012 and 0.011).The IBP of the mild group was lower than that of the moderate group and the severe group ((5.16 ± 3.41) mmHg vs.(8.02 ± 2.58) mmHg and (7.46 ± 3.48) mmHg),and the differences were statistically significant (both least-significant difference test,both P ＜0.05).The DCI of the mild group was lower than that of the moderate group ((1 241.41 ± 606.12) mmHg · s · cm vs.(1 438.55 ± 644.74) mmHg· s· cm),and the difference was statistically significant (Tamhane test,P =0.011).Conclusions Heartburn,acid reflux and dysphagia are common clinical symptoms in EGJOO patients.The weaker the peristalsis of the esophageal body of EGJOO patients,the more obvious of dysphagia.Increased IBP is an indirect manifestation of esophagogastric junction relaxation disorder.

Early Phase of Achalasia Manifested as an Esophageal Subepithelial Tumor / 대한소화기학회지

The Chicago classification (CC) defines an esophagogastric junction outflow obstruction (EGJOO) as the presence of several instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and a discrepancy from the criteria of achalasia. The revised CC addresses the potential etiology of EGJOO, including the early forms of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia. A 58-year-old woman visited the Presbyterian Medical Center with swallowing difficulty. The patient underwent a high resolution manometry (HRM) examination and was diagnosed with EGJOO. Chest CT was performed to exclude a mechanical obstruction as a cause, and CT revealed a subepithelial tumor (SET) at the upper part of the esophagogastric junction. Therefore, laparoscopic surgery was performed and eccentric muscular hypertrophy of the distal esophagus was observed. Longitudinal myotomy and Dor fundoplication were also performed. The histology findings of the surgical specimens were consistent with achalasia. This paper reports a case of early achalasia that was finally diagnosed by the histology findings, but was initially diagnosed as EGJOO using HRM and misdiagnosed as SET in the image study.

Early Phase of Achalasia Manifested as an Esophageal Subepithelial Tumor / 대한소화기학회지

The Chicago classification (CC) defines an esophagogastric junction outflow obstruction (EGJOO) as the presence of several instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and a discrepancy from the criteria of achalasia. The revised CC addresses the potential etiology of EGJOO, including the early forms of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia. A 58-year-old woman visited the Presbyterian Medical Center with swallowing difficulty. The patient underwent a high resolution manometry (HRM) examination and was diagnosed with EGJOO. Chest CT was performed to exclude a mechanical obstruction as a cause, and CT revealed a subepithelial tumor (SET) at the upper part of the esophagogastric junction. Therefore, laparoscopic surgery was performed and eccentric muscular hypertrophy of the distal esophagus was observed. Longitudinal myotomy and Dor fundoplication were also performed. The histology findings of the surgical specimens were consistent with achalasia. This paper reports a case of early achalasia that was finally diagnosed by the histology findings, but was initially diagnosed as EGJOO using HRM and misdiagnosed as SET in the image study.