Single-center study on the relationship between the clinical features of functional esophagogastric junction outflow obstruction and esophageal motility / 中华消化杂志

ABSTRACT

Objective:To analyze the clinical characteristics of functional esophagogastric junction outflow obstruction (EGJOO) and to improve the knowledge of functional EGJOO.Methods:From January 2015 to December 2019, at the Gastrointestinal Motility Center of The First Affiliated Hospital with Nanjing Medical University, 91 patients who underwent high resolution esophageal manometry (HREM) and met the EGJOO criteria of Chicago Classification for esophageal motility disorders, 3rd edition and excluded organic diseases by examination such as gastroscopy or upper gastrointestinal radiography were collected. The clinical manifestations, treatment methods, effect and clinical outcome of patients with functional EGJOO, the HREM parameters of patients with different clinical manifestations as well as symptoms and HREM parameters of patients with different treatments were analyzed. Least significant difference test or Tamhanes T2 test, Mann-Whitney U or Wilcoxon test, chi-square test or Fisher exact test were used for statistical analysis. Results:The most common symptom of 91 functional EGJOO patients was dysphagia (34/91, 37.4%). The lower esophageal sphincter pressure (LESP) and the intrabolus pressure during relaxation of the lower esophageal sphincter (IBP LESR) of patients with dysphagia were both higher than those of patients without dysphagia (30.95 mmHg (26.27 mmHg, 39.37 mmHg) (1 mmHg=0.133 kPa) vs. 27.35 mmHg (24.60 mmHg, 34.87 mmHg); (8.25±4.64) mmHg vs. (5.69±4.65) mmHg), and the differences were statistically significant ( Z=2.076, t=2.539; P=0.038, 0.013). Thirty patients (33.0%) had no special treatment, 52 patients (57.1%) were treated with medication, and nine patients (10.0%) underwent peroral endoscopic myotomy (POEM). The incidence of dysphagia before treatment and maximum intrabolus pressure of patients who underwent POEM were both higher than those of patients without special treatment and medication treatment (8/9 vs 43.3%, 13/30 and 25.0%, 13/52; 21.80 mmHg (15.45 mmHg, 28.95 mmHg) vs. 12.20 mmHg (10.00 mmHg, 18.10 mmHg) and 13.70 mmHg (11.07 mmHg, 17.82 mmHg)), and the differences were statistically significant (Fisher exact test, Fisher exact test; Z=2.814, 2.390; P=0.023, P<0.01, P=0.005, 0.017). The incidences of delayed esophageal emptying or esophageal dilation of patients who underwent POEM, without special treatment and with medication treatment was 6/9, 5/14 and 3/18, respectively, and the differences were statistically significant among three groups (Fisher exact test, P=0.039). Among them, the incidence of delayed esophageal emptying or esophageal dilation of patients received POEM before treatment was higher than that of patients with medication treatment (Fisher exact test, P=0.026). The symptoms of 24.2% (22/91) was spontaneously relieved, and two patients (2.2%) developed type Ⅱ achalasia during follow-up. Conclusions:The main manifestation of patients with functional EGJOO is dysphagia. Patients with significantly increased LESP and IBP LESP are more likely to have dysphagia. Patients with obvious signs of esophageal gastric junction obstruction are more inclined to choose POEM treatment. Some patients with functional EGJOO can relieve themselves, and a few patients can develop achalasia.