Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non-Achalasia Dysphagia

2018 ◽  
Vol 113 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Wojciech Blonski ◽  
Ambuj Kumar ◽  
John Feldman ◽  
Joel E Richter
Keyword(s):  
Predictive Value ◽  
Esophagogastric Junction ◽  
Barium Swallow ◽  
Outflow Obstruction ◽  
Diagnostic Role

Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?

2021 ◽  
Author(s):  
Claire A Beveridge ◽  
Joseph R Triggs ◽  
Shivani U Thanawala ◽  
Nitin K Ahuja ◽  
Gary W Falk ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Barium Swallow ◽  
Outflow Obstruction ◽  
Chi Square ◽  
Bolus Transit ◽  
Paired Samples ◽  
Eckardt Score ◽  
Symptom Response ◽  
Clinically Significant

Abstract Background Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment. Methods A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations. Results Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03. Conclusion This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.

Esophagogastric junction outflow obstruction

2021 ◽  
Author(s):  
Albert J. Bredenoord ◽  
Arash Babaei ◽  
Dustin Carlson ◽  
Taher Omari ◽  
Jun Akiyama ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Outflow Obstruction

scholarly journals Physiological and pathological roles of the accommodation response in lower esophageal sphincter relaxation during wet swallows

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazumasa Muta ◽  
Eikichi Ihara ◽  
Shohei Hamada ◽  
Hiroko Ikeda ◽  
Masafumi Wada ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Resolution ◽  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Relaxation Function ◽  
Esophagogastric Junction ◽  
Prospective Observational Study ◽  
Outflow Obstruction ◽  
High Resolution Manometry ◽  
Esophageal Sphincter

AbstractThe preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, however, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. To address this problem, we conducted a prospective observational study of 38 patients with normal high-resolution manometry (HRM) and 23 patients with idiopathic esophagogastric junction outflow obstruction (EGJOO) to assess dry and wet swallows. The LES accommodation measurement was proposed for practical use in evaluating the LES accommodation response. Although swallow-induced LES relaxation was observed in both dry and wet swallows, LES accommodation (6.4, 3.1–11.1 mmHg) was only observed in wet swallows. The extent of LES accommodation was impaired in idiopathic EGJOO (0.6, − 0.6–6 mmHg), and the LES accommodation measurement of patients with idiopathic EGJOO (36.8, 29.5–44.3 mmHg) was significantly higher in comparison to those with normal HRM (23.8, 18–28.6 mmHg). Successful LES relaxation in wet swallowing can be achieved by LES accommodation in combination with swallow-induced LES relaxation. Impaired LES accommodation is characteristic of idiopathic EGJOO. In addition to the IRP value, the LES accommodation measurement may be useful for evaluating the LES relaxation function in clinical practice.

Sa1329 Bolus Clearance in Esophagogastric Junction Outflow Obstruction Is Associated With Strength of Peristalsis

2016 ◽  
Vol 150 (4) ◽  
pp. S284-S285
Author(s):  
Anand Jain ◽  
Jason Baker ◽  
Joel H. Rubenstein ◽  
Joan W. Chen
Keyword(s):  
Esophagogastric Junction ◽  
Outflow Obstruction
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