The Clinical Relevance of Manometric Esophagogastric Junction Outflow Obstruction Can Be Determined Using Rapid Drink Challenge and Solid Swallows.
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
received:
29
05
2020
accepted:
08
09
2020
pubmed:
3
11
2020
medline:
2
3
2021
entrez:
2
11
2020
Statut:
ppublish
Résumé
Esophagogastric junction outflow obstruction (EGJOO) defined on high-resolution esophageal manometry (HRM) poses a management dilemma given marked variability in clinical manifestations. We hypothesized that findings from provocative testing (rapid drink challenge and solid swallows) could determine the clinical relevance of EGJOO. In a retrospective cohort study, we included consecutive subjects between May 2016 and January 2020 with EGJOO. Standard HRM with 5-mL water swallows was followed by provocative testing. Barium esophagography findings were obtained. Cases with structural obstruction were separated from functional EGJOO, with the latter categorized as symptom-positive or symptom-negative. Only symptom-positive subjects were considered for achalasia-type therapies. Sensitivity and specificity for clinically relevant EGJOO during 5-mL water swallows, provocative testing, and barium were calculated. Of the 121 EGJOO cases, 76% had dysphagia and 25% had holdup on barium. Ninety-seven cases (84%) were defined as functional EGJOO. Symptom-positive EGJOO subjects were more likely to demonstrate abnormal motility and pressurization patterns and to reproduce symptoms during provocative testing, but not with 5-mL water swallows. Twenty-nine (30%) functional EGJOO subjects underwent achalasia-type therapy, with symptomatic response in 26 (90%). Forty-eight (49%) functional EGJOO cases were managed conservatively, with symptom remission in 78%. Although specificity was similar, provocative testing demonstrated superior sensitivity in identifying treatment responders from spontaneously remitting EGJOO (85%) compared with both 5-mL water swallows (54%; P < 0.01) and barium esophagography (54%; P = 0.02). Provocative testing during HRM is highly accurate in identifying clinically relevant EGJOO that benefits from therapy and should be routinely performed as part of the manometric protocol.
Identifiants
pubmed: 33136563
pii: 00000434-202102000-00018
doi: 10.14309/ajg.0000000000000988
doi:
Substances chimiques
Barium Compounds
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
280-288Informations de copyright
Copyright © 2020 by The American College of Gastroenterology.
Références
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterology Motil 2015;27:160–74.
Richter JE, Clayton SB. Diagnosis and management of esophagogastric junction outflow obstruction. Am J Gastroenterol 2019;114:544–7.
Babaei A, Lin EC, Szabo A, et al. Determinants of pressure drift in Manoscan esophageal high-resolution manometry system. Neurogastroenterology Motil 2015;27:277–84.
Babaei A, Szabo A, Yorio SD, et al. Pressure exposure and catheter impingement affect the recorded pressure in the Manoscan 360 system. Neurogastroenterology Motil 2018;30:e13329.
Clayton SB, Shin CM, Ewing A, et al. Pneumatic dilation improves esophageal emptying and symptoms in patients with idiopathic esophago-gastric junction outflow obstruction. Neurogastroenterology Motil 2019;31:e13522.
Lynch KL, Yang XY, Metz DC, et al. Clinical presentation and disease course of patients with esophagogastric junction outflow obstruction. Dis Esophagus 2017;30:1–6.
Liu A, Woo M, Nasser Y, et al. Esophagogastric junction outflow obstruction on manometry: Outcomes and lack of benefit from CT and EUS. Neurogastroenterology Motil 2019;31:e13712.
DeLay K, Austin GL, Menard-Katcher P. Anatomic abnormalities are common potential explanations of manometric esophagogastric junction outflow obstruction. Neurogastroenterology Motil 2016;28:1166–71.
Biasutto D, Mion F, Garros A, et al. Rapid drink challenge test during esophageal high resolution manometry in patients with esophago-gastric junction outflow obstruction. Neurogastroenterology Motil 2018;30:e13293.
Triggs JR, Carlson DA, Beveridge C, et al. Upright integrated relaxation pressure facilitates characterization of esophagogastric junction outflow obstruction. Clin Gastroenterol Hepatol 2019;17:2218–26.e2.
Misselwitz B, Hollenstein M, Bütikofer S, et al. Prospective serial diagnostic study: The effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry. Aliment Pharmacol Ther 2020;51:706–18.
Clayton SB, Patel R, Richter JE. Functional and anatomic esophagogastic junction outflow obstruction: Manometry, timed barium esophagram findings, and treatment outcomes. Clin Gastroenterol Hepatol 2016;14:907–11.
Triggs JR, Carlson DA, Beveridge C, et al. Functional luminal imaging probe panometry identifies achalasia-type esophagogastric junction outflow obstruction. Clin Gastroenterol Hepatol 2020;18:2209–17.
Sanagapalli S, Roman S, Hastier A, et al. Achalasia diagnosed despite normal integrated relaxation pressure responds favorably to therapy. Neurogastroenterology Motil 2019;31:e13586.
Wang YT, Tai LF, Yazaki E, et al. Investigation of dysphagia after antireflux surgery by high-resolution manometry: Impact of multiple water swallows and a solid test meal on diagnosis, management, and clinical outcome. Clin Gastroenterol Hepatol 2015;13:1575–83.
Ang D, Hollenstein M, Misselwitz B, et al. Rapid drink challenge in high-resolution manometry: An adjunctive test for detection of esophageal motility disorders. Neurogastroenterology Motil 2016;29:e12902.
Ang D, Misselwitz B, Hollenstein M, et al. Diagnostic yield of high-resolution manometry with a solid test meal for clinically relevant, symptomatic oesophageal motility disorders: Serial diagnostic study. Lancet Gastroenterol Hepatol 2017;2:654–61.
Sanagapalli S, Emmanuel A, Leong R, et al. Impaired motility in Barrett's esophagus: A study using high-resolution manometry with physiologic challenge. Neurogastroenterology Motil 2018;30:e13330.
Hollenstein M, Thwaites P, Bütikofer S, et al. Pharyngeal swallowing and oesophageal motility during a solid meal test: A prospective study in healthy volunteers and patients with major motility disorders. Lancet Gastroenterol Hepatol 2017;2:644–53.
Sweis R, Anggiansah A, Wong T, et al. Normative values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry. Neurogastroenterology Motil 2011;23:509.
Sweis R, Anggiansah A, Wong T, et al. Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: Development and clinical validation of a new methodology utilizing high-resolution manometry. Neurogastroenterology Motil 2014;26:215–28.
de Oliveira JM, Birgisson S, Doinoff C, et al. Timed barium swallow: A simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol 1997;169:473–9.
Moonen A, Annese V, Belmans A, et al. Long-term results of the European achalasia trial: A multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016;65:732–9.
Scherer JR, Kwiatek MA, Soper NJ, et al. Functional esophagogastric junction obstruction with intact peristalsis: A heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg 2009;13:2219–25.
van Hoeij FB, Smout A, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction. Neurogastroenterology Motil 2015;27:1310–6.
Okeke FC, Raja S, Lynch KL, et al. What is the clinical significance of esophagogastric junction outflow obstruction? Evaluation of 60 patients at a tertiary referral center. Neurogastroenterology Motil 2017;29:e13061.
Pérez-Fernández MT, Santander C, Marinero A, et al. Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry. Neurogastroenterology Motil 2016;28:116–26.
Schupack D, Katzka DA, Geno DM, et al. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neurogastroenterology Motil 2017;29:1–9.
Vaezi MF, Richter JE, Wilcox CM, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: A randomised trial. Gut 1999;44:231.
Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med 2011;364:1807–16.
Ponds FA, Fockens P, Lei A, et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia. JAMA 2019;322:134–44.
Reitsma JB, Rutjes AW, Khan KS, et al. A review of solutions for diagnostic accuracy studies with an imperfect or missing reference standard. J Clin Epidemiol 2009;62:797–806.
Sanagapalli S, Sweis R. Achalasia: It is not all black and white. Curr Gastroenterol Rep 2017;19:27.