The conundrum of esophagogastric junction outflow obstruction: Answers to key clinical questions.

Pierfrancesco Visaggi, Justin Wu, Stefano Siboni, Joshua A Sloan, Sravanya Gavini, C Prakash Gyawali, Enrique Coss-Adame, Kristle Lee Lynch, Christopher Vélez, Abraham Khan, Marco Sozzi

Journal: Annals of the New York Academy of Sciences 2025;1549(1):5-10

PMID: 40452117

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Abstract

Esophagogastric junction outflow obstruction (EGJOO) is a heterogeneous disorder characterized by abnormal esophagogastric junction residual pressures in the setting of intact esophageal body peristalsis. This manometric finding is most clinically relevant in patients with dysphagia and chest pain, and may arise from various mechanisms, including structural processes, catheter positioning artifact, and medications. Rarely, manometric EGJOO is a consequence of abnormal relaxation of the lower esophageal sphincter (LES) akin to achalasia. Thus, it is critical in the evaluation of EGJOO to determine if a true pressure gradient exists across the esophagogastric junction (EGJ) that warrants therapy. There are many unanswered questions in EGJOO diagnosis and management, which are addressed in this review in the context of the use of provocative maneuvers during high-resolution manometry, complementary and alternate testing, and therapeutic options.

Address: Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.; Division of Gastroenterology Washington University School of Medicine, St. Louis, Missouri, USA.; Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México.; Department of General and Emergency Surgery, IRCCS Policlinico San Donato, Milan, Italy.; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA.; Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Division of Gastroenterology & Hepatology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong.

DOI: 10.1111/nyas.15362

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MeSH Terms: Humans, Esophagogastric Junction, Manometry, Esophageal Achalasia, Esophageal Motility Disorders, Deglutition Disorders, Peristalsis, Esophageal Sphincter, Lower