TY - JOUR
T1 - Esophagogastric junction outflow obstruction
AU - Bredenoord, Albert J.
AU - Babaei, Arash
AU - Carlson, Dustin
AU - Omari, Taher
AU - Akiyama, Jun
AU - Yadlapati, Rena
AU - Pandolfino, John E.
AU - Richter, Joel
AU - Fass, Ronnie
N1 - Funding Information: AJB received research funding from Nutricia, Norgine, SST and Bayer and received speaker and/or consulting fees from Laborie, Arena, EsoCap, Medtronic, Dr. Falk Pharma, Calypso Biotech, Alimentiv, Reckett Benkiser, Regeneron and AstraZeneca. DC: Medtronic (Speaking, Consulting). RF: Medtronic (Consulting), Diversatek (Speaker and Research grants). RY: Institutional Consulting Agreement: Medtronic, Ironwood Pharmaceuticals, Diversatek; Consultant: Phathom Pharmaceuticals; Research support: Ironwood Pharmaceuticals; Advisory Board with Stock Options: RJS Mediagnostix; AB, TO, JA and JR have nothing to disclose. JEP: Medtronic (Licensing, Speaker, Consultant, shared patent for FLIP Panometry), Diversatek (Consulting, Grant), Ethicon (Consultant, Speaking), Takeda (Consultant, Grant), Ironwood (Consulting, Grant), Endogastric Solutions (Speaking). Publisher Copyright: © 2021 John Wiley & Sons Ltd
PY - 2021/9
Y1 - 2021/9
N2 - In the Chicago Classification version 4.0 (CCv4), esophagogastric junction outflow obstruction (EGJOO) is manometrically defined as an elevated median integrated relaxation pressure (IRP) and elevated intrabolus pressure (IBP) during supine wet swallows, and persistently elevated median IRP in the upright position. A clinically relevant conclusive diagnosis of EGJOO requires a manometric diagnosis of EGJOO and associated symptoms such as dysphagia and/or chest pain with at least one of the following supportive investigations (pharmacologic provocation, timed barium esophagogram, and/or endoflip). The Chicago Classification is intended for diagnosis of primary esophageal motor disorders, and thus history and endoscopic evaluation are important to exclude conditions (eg, previous surgery, strictures, or masses) that can secondarily generate the EGJOO pattern on HRM. While a manometric finding of EGJOO is often made and can be an early sign of achalasia, more often it is a manometric finding without clinical implications. The proposed changes in CC4.0 have attempted to make the diagnosis more specific, in order to reduce the number of clinically irrelevant diagnoses and avoid confusion by patients and physicians alike.
AB - In the Chicago Classification version 4.0 (CCv4), esophagogastric junction outflow obstruction (EGJOO) is manometrically defined as an elevated median integrated relaxation pressure (IRP) and elevated intrabolus pressure (IBP) during supine wet swallows, and persistently elevated median IRP in the upright position. A clinically relevant conclusive diagnosis of EGJOO requires a manometric diagnosis of EGJOO and associated symptoms such as dysphagia and/or chest pain with at least one of the following supportive investigations (pharmacologic provocation, timed barium esophagogram, and/or endoflip). The Chicago Classification is intended for diagnosis of primary esophageal motor disorders, and thus history and endoscopic evaluation are important to exclude conditions (eg, previous surgery, strictures, or masses) that can secondarily generate the EGJOO pattern on HRM. While a manometric finding of EGJOO is often made and can be an early sign of achalasia, more often it is a manometric finding without clinical implications. The proposed changes in CC4.0 have attempted to make the diagnosis more specific, in order to reduce the number of clinically irrelevant diagnoses and avoid confusion by patients and physicians alike.
KW - achalasia
KW - dysphagia
KW - high-resolution manometry
KW - outflow obstruction
UR - http://www.scopus.com/inward/record.url?scp=85107722827&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/nmo.14193
DO - https://doi.org/10.1111/nmo.14193
M3 - Article
C2 - 34120375
SN - 1350-1925
VL - 33
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 9
M1 - e14193
ER -