Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates

doi:10.3748/wjg.v28.i30.4163

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Aug 14, 2022 (publication date) through May 6, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Aug 14, 2022; 28(30): 4163-4173
Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4163

Table 1 Patient characteristics

	EGJOO (n = 24)	Isolated supine IRP elevated (n = 27)	Normal HRM (n = 46)	P value
Demographics
Age (yr)	62.7 ± 2.7^a	56.6 ± 11.1	50.2 ± 2.2	0.001
Female, n (%)	14 (58.3)	19 (70.4)	24 (52.2)	0.312
BMI (kg/m²)	23.29 ± 0.63	21.88 ± 2.50	23.17 ± 0.68	0.300
Dominant symptom
Dysphagia, n (%)	7 (29.2)	6 (22.2)	7 (15.2)	0.380
Retrosternal pain, n (%)	5 (20.8)	3 (11.1)	8 (17.4)	0.630
Regurgitation, n (%)	8 (33.3)	9 (33.3)	15 (32.6)	0.997

^aP < 0.05, compared with normal high-resolution manometry group.

BMI: Body mass index; EGJOO: Esophagogastric junction outflow obstruction; IRP: Integrated relaxation pressure; HRM: High-resolution manometry.

Table 2 High-resolution manometry parameters of the patients

HRM findings	EGJOO (n = 24)	Isolated supine IRP elevated (n = 27)	Normal HRM (n = 46)	P value
UES parameters
UESL (cm)	3.13 ± 0.18	3.01 ± 0.67	3.34 ± 0.12	0.206
UESP (mmHg)	53.35 ± 5.28	68.12 ± 6.35	57.77 ± 3.35	0.123
UESNP (mmHg)	3.00 ± 1.43^a	3.50 ± 6.57^a	-4.08 ± 0.84	< 0.001
PD-UESCI (mmHg∙s∙cm)	430.01 ± 32.90	527.41 ± 37.48	534.13 ± 34.40	0.118
Proximal esophageal parameters
PEL (cm)	4.89 ± 0.27^a	5.89 ± 0.32^b	6.08 ± 0.14	0.001
PL (s)	1.99 ± 0.08	2.05 ± 0.08	2.04 ± 0.07	0.872
PECI (mmHg∙s∙cm)	238.34 ± 35.18^a	328.00 ± 35.15	367.99 ± 37.88	0.048
Esophageal body parameters
DL (s)	6.14 ± 0.25	6.85 ± 0.32	6.25 ± 0.14	0.078
DCI (mmHg∙s∙cm)	1581.21 ± 276.20	1655.80 ± 170.33	1705.41 ± 144.27	0.897
ES-RDC (%)	37.5% (9)	18.5% (5)	13.0% (6)	0.053
EGJ parameters
LESP (mmHg)	47.91 ± 4.05^a	35.68 ± 1.80^a^,^b	23.89 ± 1.34	< 0.001
IBP (mmHg)	12.29 ± 1.37^a	7.41 ± 0.84^b	5.45 ± 0.54	< 0.001
Median supine IRP (mmHg)	27.76 ± 2.39^a	18.74 ± 0.52^a^,^b	10.48 ± 0.60	< 0.001
Median upright IRP (mmHg)	23.69 ± 2.58^a	7.32 ± 0.53^b	5.41 ± 0.84	< 0.001
IRP on RDC (mmHg)	9.96 ± 1.78^a	3.00 ± 0.98^b	2.04 ± 0.58	< 0.001

^aP < 0.05, compared with normal high-resolution manometry group.

^bP < 0.05, compared with esophagogastric junction outflow obstruction group.

IRP: Integrated relaxation pressure; EGJOO: Esophagogastric junction outflow obstruction; UES: Upper esophageal sphincter; UESL: Upper esophageal sphincter length; UESP: Upper esophageal sphincter resting pressure; UESNP: Upper esophageal sphincter nadir pressure; PD-UESCI: Postdeglutitive upper esophageal sphincter contractile integral; PEL: Proximal esophageal length; PECI: Proximal contractile integral; PL: Proximal latency; DL: Distal latency; DCI: Distal contraction integral; ES: Esophageal shortening; RDC: Rapid drink challenge; LESP: Lower esophageal sphincter resting pressure; IBP: Intrabolus pressure; HRM: High-resolution manometry.

Table 3 Multivariate logistic regression analysis for factors associated with esophagogastric junction outflow obstruction

Effect variables	OR	95%CI	P value
PEL (cm)	0.543	0.30-0.99	0.044
LESP (mmHg)	1.106	1.05-1.17	0.001
IRP on RDC (mmHg)	1.197	1.02-1.41	0.028

PEL: Proximal esophageal length; LESP: Lower esophageal sphincter resting pressure; IRP: Integrated relaxation pressure; RDC: Rapid drink challenge.

Table 4 Receiver-operating characteristic analysis for esophagogastric junction outflow obstruction

	Cutoff	AUC	95%CI	Sensitivity (%)	Specificity (%)
UESNP (mmHg)	> 1.15	0.66	0.53-0.78	63.6	68.7
PEL (cm)	< 4.76	0.67	0.55-0.80	50.0	87.7
PECI (mmHg∙s∙cm)	< 312.35	0.67	0.55-0.80	83.3	46.6
LESP (mmHg)	> 40.20	0.85	0.75-0.94	68.2	85.1
IRP on RDC (mmHg)	> 10.75	0.81	0.70-0.91	50.0	98.5

UESNP: Upper esophageal sphincter nadir pressure; PEL: Proximal esophageal length; PECI: Proximal esophageal contractile integral; LESP: Lower esophageal sphincter resting pressure; IRP: Integrated relaxation pressure; RDC: Rapid drink challenge; AUC: Area under the curve.

Citation: Li YY, Lu WT, Liu JX, Wu LH, Chen M, Jiao HM. Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates. World J Gastroenterol 2022; 28(30): 4163-4173
URL: https://www.wjgnet.com/1007-9327/full/v28/i30/4163.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i30.4163