Neena Mohan, MD1, Michelle D'Souza, MD1, Joshua DeSipio, MD2; 1Cooper University Hospital, Camden, NJ; 2Cooper Digestive Health Institute, Mt. Laurel, NJ
Introduction: The etiologies and pathogenesis of esophagogastric junction outflow obstruction (EGJOO) remain unclear in the literature, contributing to a lack of standard guidelines for management of this disorder. We performed one of the largest review studies to evaluate the potential effect of medications as causes of EGJOO. Methods: We conducted a retrospective chart review of 100 patients diagnosed with EGJOO based on the Chicago Classification and 100 control patients with dysphagia and normal esophageal manometry findings from 2010 to 2019. Data including age, sex, body mass index, past surgeries, and medications was collected. Statistical analysis was performed, and Spearman correlation co-efficient and p-value were used to determine statistical significance. Results: Of the 100 patients diagnosed with EGJOO, 65 were female and 35 were male. There were significant positive relationships between benzodiazepines and integrated relaxation pressure (IRP) (rs= 0.27588, P= 0.0055), benzodiazepines and lower esophageal sphincter mean resting pressure (LESMRP) (rs= 0.21515, P= 0.0363), antidepressants and LESMRP (rs= 0.20585, P= 0.0454), narcotics and LESMRP (rs= 0.20936, P= 0.0417), and narcotics to distal contractile integral (DCI) (rs= 0.21186, P= 0.0343). Anticonvulsants and number of swallows with complete bolus transfer (CBT) had a negative correlation (rs = -0.26578, P= 0.0310), while anticonvulsants and DCI had a positive correlation (rs= 0.19693, P= 0.0496). The differences in mean IRP, LESMRP, DCI, and CBT between the control group and the EGJOO patients with and without use of benzodiazepines, antidepressants, narcotics, and anticonvulsants were significant (p< 0.02).The mean IRP in EGJOO patients with use of benzodiazepines, narcotics, antidepressants or anticonvulsants was 24.05, 22.17, 21.32, and 25.02, respectively. The mean IRP in EGJOO patients without use of benzodiazepines, narcotics, antidepressants or anticonvulsants was 20.38, 20.72, 21.01, and 20.86, respectively. Discussion: Our study demonstrates significant correlations between particular medication classes, including benzodiazepines, narcotics, antidepressants and anticonvulsants, and esophageal function metrics in patients with EGJOO. There were also higher mean IRPs in the EGJOO patients with use of the listed medications than in EGJOO patients without their use. While our study demonstrates a strong association between the diagnosis of EGJOO and these medications, further studies should be performed to confirm causality.
Disclosures: Neena Mohan indicated no relevant financial relationships. Michelle D''Souza indicated no relevant financial relationships. Joshua DeSipio indicated no relevant financial relationships.