Kenneth DeVault, MD, FACG1, Ramsah Cheah, PhD2, Supphamat Chirnaksorn, PhD2, Dawn Francis, MPH, MD1, Ernest Bouras, MD1, Maria Vazquez-Roque, MD1, Brian E. Lacy, MD, PhD, FACG1, Lesley Houghton, PhD2
1Mayo Clinic, Jacksonville, FL; 2Leeds University, Leeds, England, United Kingdom
Introduction: High-resolution manometry using the Chicago Classification is standard in the evaluation of esophageal motility. When the relaxation of the esophagogastric junction is impaired and achalasia excluded, esophagogastric junction outflow obstruction (EGJ-OO) is diagnosed and the esophageal body is essentially ignored. We sought to characterize the function of the esophageal body in consecutive patients with EGJ-OO.
Methods: Retrospective review of the esophageal manometry findings in consecutive patients where there was computer recognition of EGJ-OO collected over a 2-month period. In each case, the esophageal body was reviewed manually and results reported independent of the suggested computer diagnosis.
Results: 116 patients underwent manometry over a 2-month period and 30 (26%) were identified as having EGJ-OO. The indications for testing included chronic cough (n=5), GERD (n=8), dysphagia (n=9) and esophageal evaluation associated with severe lung disease or transplantation (n=8). The mean IRP was 20.8 (range 16-33.6) and did not vary depending on indication(p=0.381). Computer interpretation was EGJ-OO in all patients without mention of the esophageal body. After review, 11 (37%) had an additional esophageal diagnosis. Ineffective esophageal motility(IEM)wasthe most prevalentamong them (IEM-8, achalasia-2, jackhammer esophagus-1; p=0.020). The frequencyof anadditionalesophagealdiagnosis wassignificantly different between GERD (0%) and dysphagia (66%; p=0.004), but not betweenother groups(i.e. 40% in cough and 37.5% in transplant group). An esophageal body diagnosiswassignificantly more likely inpatientswith IRP >25 (80%) compared with those with IRP< 25(28%; p=0.028).
Discussion: 1-EGJ-OO is common in patients referred for esophageal manometry. 2-An additional esophageal body diagnosis is common in those with EGJ-OO.3-Esophageal diagnoses are more common in patients with dysphagia and in those with a very high IRP. The body of the esophagus is important in cases of EGJ-OO and should be reported independent of the computer-generatedinterpretation of the Chicago Classification.
Citation: Kenneth DeVault, MD, FACG; Ramsah Cheah, PhD; Supphamat Chirnaksorn, PhD; Dawn Francis, MPH, MD; Ernest Bouras, MD; Maria Vazquez-Roque, MD; Brian E. Lacy, MD, PhD, FACG; Lesley Houghton, PhD. P1185 - ESOPHAGEAL BODY DYSFUNCTION IN PATIENTS WITH ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION: A POTENTIAL FLAW IN THE CHICAGO CLASSIFICATION. Program No. P1185. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.