University of California San Francisco Portland, OR, United States
Benjamin Hornung, MD1, David Nagle, MD2, Alexis Bayudan, MD3, Myung Ko, MD1, Andrew Nett, MD1, Priya Kathpalia, MD1 1University of California San Francisco, San Francisco, CA; 2UCSF, San Francisco, CA; 3University of California, San Francisco, San Francisco, CA
Introduction: High-resolution manometry (HRM) has provided more nuanced understanding of the relationship between esophageal body and lower esophageal sphincter pressures in patients with upper gastrointestinal symptoms. The major disorders of peristalsis are defined by an elevated integrated relaxation pressure (IRP), and further classified into achalasia or esophagogastric outflow obstruction (EGJOO) based upon the absence or presence of preserved peristalsis. While pneumatic balloon dilation or myotomy are effective therapies in patients with EJGOO, it is unclear which patients are more likely to benefit from treatment. The relationships between EGJOO and other routinely obtained measurements on HRM have yet to be elucidated and may help define the patient population which may benefit from treatment.
Methods: In this single-center retrospective cohort study, we identified patients with symptoms of dysphagia and controls without dysphagia who underwent HRM from 8/2017 until present with the manometric findings of EGJOO (IRP >15 with intact peristalsis). Manometric data were obtained and the electronic medical record was used to obtain clinical data including demographics, clinical history, and imaging findings.
Results: 76 patients were screened for inclusion over the study period. Two patients were excluded due to incomplete manometric data. Of the remaining 74 patients with EGJOO, 48 patients reported dysphagia as an indication for manometry, and 26 patients had an alternative indication. Only 20/76 patients (11.4%) with EGJOO were found to have a hiatal hernia. Patients with an IRP >25mmHg were more likely to report dysphagia than subgroups of 15-20mmHg and 20-25mmHg though the difference was not significant. Of the 6 symptomatic patients with dysphagia with incomplete bolus clearance, 4 were noted to have compartmentalization of pressures (66%), and 5 had an IRP >25mmHg (83%, p=0.08).
Discussion: Conclusion: EGJOO is not associated with the presence of hiatal hernia and is never the cause of this manometric finding. Among those with EGJOO, higher degrees of IRP elevation may correlate with the presence of symptomatic dysphagia. Among those with EGJOO, a higher degree of IRP elevation and compartmentalization of pressures may correlate with functionally relevant impaired bolus clearance. In EGJOO, concomitant high IRP elevation and compartmentalization of pressures may help identify patients that would preferentially benefit from endoscopic therapy.
Disclosures: Benjamin Hornung: Toi Labs, LLC – Consultant. David Nagle indicated no relevant financial relationships. Alexis Bayudan indicated no relevant financial relationships. Myung Ko indicated no relevant financial relationships. Andrew Nett indicated no relevant financial relationships. Priya Kathpalia indicated no relevant financial relationships.
Benjamin Hornung, MD1, David Nagle, MD2, Alexis Bayudan, MD3, Myung Ko, MD1, Andrew Nett, MD1, Priya Kathpalia, MD1. P0298 - Clinical Characteristics of Patients With Esophagogastric Junction Outflow Obstruction, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.