Chen Songfeng, Liang Mengya, Tan Niandi, Zhang Mengyu, Lin Yuqing, Cao Peixian, Zhuang Qianjun, Xiao Yinglian
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Cardian Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
J Neurogastroenterol Motil. 2021 Jul 30;27(3):363-369. doi: 10.5056/jnm20106.
BACKGROUND/AIMS: Esophagogastric junction outflow obstruction (EGJOO) is characterized by elevated integrated relaxation pressure (IRP) and preserved esophageal peristalsis. The clinical significance of EGJOO is uncertain. This study aim to describe the clinical characteristics of these patients and to find out potential parameters to predict patients' symptom outcome.
Consecutive patients who received high-resolution manometry examination in our hospital in 2013-2019 and met the diagnostic criteria of EGJOO were retrospectively included. Motility and reflux parameters as well as endoscopy and barium esophagogram results were studied and compared. Patients were also followed up to record their treatment methods and symptom outcomes.
A total of 138 EGJOO (accounting for 5.2% of total patients taking high-resolution manometry examination in our hospital) patients were included. Only 2.9% of these patients had persistent dysphagia. A total of 81.8% of EGJOO patients had symptom resolution during follow-up. Patients with persistent dysphagia had significantly higher upright IRP (16.6 [10.3, 19.8] vs 7.8 [3.2, 11.5]; = 0.026) than those without. Upright IRP can effectively distinguished patients with persistent dysphagia (area under curve: 0.826; = 0.026) using optimal cut-off value of 9.05 mmHg.
EGJOO patients with persistent dysphagia and higher upright IRP (median > 9.05 mmHg) needs further evaluation and aggressive management.
背景/目的：食管胃交界部流出道梗阻（EGJOO）的特征是综合松弛压（IRP）升高且食管蠕动保留。EGJOO的临床意义尚不确定。本研究旨在描述这些患者的临床特征，并找出预测患者症状结局的潜在参数。
回顾性纳入2013年至2019年在我院接受高分辨率测压检查且符合EGJOO诊断标准的连续患者。研究并比较了运动和反流参数以及内镜检查和食管钡餐造影结果。还对患者进行随访，记录其治疗方法和症状结局。
共纳入138例EGJOO患者（占我院接受高分辨率测压检查患者总数的5.2%）。这些患者中只有2.9%有持续性吞咽困难。共有81.8%的EGJOO患者在随访期间症状缓解。有持续性吞咽困难的患者直立位IRP显著高于无持续性吞咽困难的患者（16.6[10.3，19.8] vs 7.8[3.2，11.5]；P = 0.026）。直立位IRP使用最佳截断值9.05 mmHg可有效区分有持续性吞咽困难的患者（曲线下面积：0.826；P = 0.026）。
有持续性吞咽困难且直立位IRP较高（中位数>9.05 mmHg）的EGJOO患者需要进一步评估和积极治疗。
