Zikos Thomas A, Triadafilopoulos George, Clarke John O
Stanford Multidimensional Program for Innovation and Research in the Esophagus (S-MPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street, Pavilion C, 3rd Floor, GI suite, Redwood City, CA, 94063, USA.
Curr Gastroenterol Rep. 2020 Feb 5;22(2):9. doi: 10.1007/s11894-020-0743-0.
We summarize the current epidemiology, presentation, diagnostic workup, and treatment of esophagogastric junction outflow obstruction (EGJOO). We also propose a treatment algorithm based upon the literature and our personal clinical experience.
EGJOO can be caused by functional obstruction (akin to achalasia), mechanical obstruction, medications, or artifact. High-resolution esophageal manometry is currently the gold standard of diagnosis. Recent research on FLIP (functional lumen imaging probe) and timed barium support use as adjunctive testing. The diagnostic yield of cross-sectional imaging is low. Current diagnostic testing and treatment should be targeted to the suspected underlying etiology and clinical presentation of EGJOO. If functional obstruction is present with significant and persistent dysphagia, and either an abnormal FLIP or timed barium swallow, we consider therapy aimed at LES disruption (similar to achalasia). Pharmacologic therapy has a limited role. More research is needed on diagnostic and treatment modalities.
我们总结了食管胃交界部流出道梗阻（EGJOO）的当前流行病学、临床表现、诊断检查及治疗方法。我们还根据文献及个人临床经验提出了一种治疗算法。
EGJOO可由功能性梗阻（类似于贲门失弛缓症）、机械性梗阻、药物或假象引起。高分辨率食管测压目前是诊断的金标准。近期对功能性管腔成像探头（FLIP）及定时钡餐检查作为辅助检测手段的研究。横断面成像的诊断价值较低。当前的诊断检查及治疗应针对EGJOO的疑似潜在病因及临床表现。如果存在功能性梗阻且伴有严重且持续的吞咽困难，同时FLIP或定时钡餐检查异常，我们考虑采取针对LES破坏的治疗（类似于贲门失弛缓症）。药物治疗作用有限。在诊断及治疗方式方面还需要更多研究。
