What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center

F. C. Okeke, S. Raja, K. L. Lynch, S. Dhalla, M. Nandwani, E. M. Stein, B. Chander Roland, M. A. Khashab, P. Saxena, V. Kumbhari, N. K. Ahuja, J. O. Clarke

Research output: Contribution to journalArticlepeer-review


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. Key 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 & Inferences: 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.

Original languageEnglish (US)
Article numbere13061
JournalNeurogastroenterology and Motility
Issue number6
StatePublished - Jun 2017


  • dysphagia
  • esophagogastric outflow obstruction (EGJOO)
  • high-resolution esophageal pressure topography (HREPT)

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology


Dive into the research topics of 'What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center'. Together they form a unique fingerprint.

Cite this