Lee Geon Woo, Kim Su Jin, Choi Cheol Woong, Park Su Bum, Ryu Dae Gon, Kim Woo Jin
Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Medicine (Baltimore). 2025 Jun 20;104(25):e43005. doi: 10.1097/MD.0000000000043005.
The Chicago Classification version 4.0 categorizes esophagogastric junction outflow obstruction (EGJOO) into 4 subgroups based on peristalsis patterns. Recent proposals introduce new terminology, grouping EGJOO with distal esophageal spasm and a hypercontractile esophagus as major mixed motility disorders (MMMDs), while classifying ineffective esophageal motility and normal peristalsis as isolated or ineffective esophagogastric junction outflow obstruction (IEGJOO). Botulinum toxin (Botox) injection is considered a cost-effective, minimally invasive treatment option for EGJOO. This study aimed to investigate clinical outcomes of Botox injection based on these subgroups. We included all patients over 18 years old who underwent high-resolution manometry at our institution between May 2019 and December 2023. Patients diagnosed with EGJOO and treated with Botox injections were categorized into subgroups. Clinical outcomes were assessed using Eckardt scores (ESs) at diagnosis and 2 months posttreatment. Among 180 patients, 31 met the Chicago Classification 4.0 criteria for EGJOO, and 22 of these received Botox injections. Six of these patients had MMMD, and 16 had ineffective esophagogastric junction outflow obstruction. MMMD showed a higher distal contractile integral, but no other significant differences in high-resolution manometry were observed. Patients with MMMD had higher posttreatment ESs (5.50 [2.75-6.25] vs 2.00 [1.00-2.75]; P = .009) and lower changes in ESs (1.00 [0.75-2.50] vs 4.00 [2.25-4.75]; P =.010) when compared to those with IEGJOO. This study suggests that Botox injection is less effective in treating MMMD compared to IEGJOO, which may impact treatment strategies for different EGJOO subgroups.
芝加哥分类第4.0版根据蠕动模式将食管胃交界部流出道梗阻（EGJOO）分为4个亚组。最近的提议引入了新术语，将EGJOO与远端食管痉挛和高收缩性食管归为主要混合运动障碍（MMMDs），而将无效食管运动和正常蠕动归类为孤立性或无效食管胃交界部流出道梗阻（IEGJOO）。肉毒杆菌毒素（Botox）注射被认为是EGJOO一种经济有效的微创治疗选择。本研究旨在探讨基于这些亚组的Botox注射的临床结果。我们纳入了2019年5月至2023年12月在我们机构接受高分辨率测压的所有18岁以上患者。诊断为EGJOO并接受Botox注射治疗的患者被分为亚组。使用诊断时和治疗后2个月的埃卡德特评分（ESs）评估临床结果。在180例患者中，31例符合芝加哥分类第4.0版EGJOO标准，其中22例接受了Botox注射。这些患者中有6例患有MMMD，16例患有无效食管胃交界部流出道梗阻。MMMD显示出更高的远端收缩积分，但在高分辨率测压中未观察到其他显著差异。与IEGJOO患者相比，MMMD患者治疗后的ESs更高（5.50[2.75 - 6.25]对2.00[1.00 - 2.75]；P = 0.009），ESs的变化更低（1.00[0.75 - 2.50]对4.00[2.25 - 4.75]；P = 0.010）。本研究表明，与IEGJOO相比，Botox注射治疗MMMD的效果较差，这可能会影响不同EGJOO亚组的治疗策略。
