Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4163
Peer-review started: March 10, 2022
First decision: April 11, 2022
Revised: April 21, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 14, 2022
Processing time: 152 Days and 16.5 Hours
The critical diagnostic criteria for esophagogastric junction outflow obstruction (EGJOO) were published in the latest Chicago Classification version 4.0 (CCv4.0). However, as a result of the diagnostic criteria modifications, the changes in manometric features of EGJOO remained unclear.
To investigate the changes of EGJOO manometric features according to the Chicago Classification updates.
This study focused on evaluating the esophageal motility characteristics of patients with EGJOO, and selecting valuable parameters that are supportive for confirming the diagnosis of EGJOO.
A total of 97 patients were enrolled, with 24 patients that met the updated manometric diagnosis of EGJOO (CCv4.0), 27 patients that only met the previous criteria, and 46 patients with normal manometric features served as the normal high-resolution manometry (HRM) group for this study. We collected clinical data, HRM parameters, and conducted comparisons among groups. Factors associated with EGJOO were illustrated by multivariate analysis. Furthermore, valuable parameters that strengthen the confidence in an EGJOO diagnosis were selected by the receiver-operating characteristic analysis.
EGJOO patients revealed significantly decreased proximal esophageal contractile integral (PECI) and proximal esophageal length (PEL) compared to the normal HRM group, and the features were related to dysphagia. EGJOO patients also had more severe dysfunction of the esophagogastric junction including lower esophageal sphincter resting pressure (LESP), intrabolus pressure, median supine integrated relaxation pressure (IRP), median upright IRP, and IRP on rapid drink challenge (RDC) than patients that only met the previous criteria. Further multivariate analysis revealed that the PEL, LESP, and IRP on RDC are factors associated with EGJOO. Additionally, the upper esophageal sphincter nadir pressure, PECI, PEL, LESP, and IRP on RDC contributes to confirming the diagnosis of EGJOO.
The updates of Chicago Classification have improved the precision for identification of EGJ dysfunction that may reduce over-diagnosing for EGJOO. The motility disorder of EGJOO is implicated in the proximal esophagus, and the changes of proximal esophagus may relate to dysphagia. Additionally, there are valuable parameters that can be applied for confirming the diagnosis of EGJOO.
Further investigations are required to reveal the pathophysiological mechanism of the abnormal proximal esophageal motility showed in EGJOO patients, and larger cohorts are required to explore the prognostic value of the parameters mentioned above.