scholarly journals Upright Integrated Relaxation Pressure Predicts Symptom Outcome for Esophagogastric Junction Outflow Obstruction

2021 ◽  
Vol 27 (3) ◽  
pp. 363-369
Author(s):  
Songfeng Chen ◽  
Mengya Liang ◽  
Niandi Tan ◽  
Mengyu Zhang ◽  
Yuqing Lin ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
Symptom Outcome ◽  
Integrated Relaxation Pressure

scholarly journals Upright Integrated Relaxation Pressure Facilitates Characterization of Esophagogastric Junction Outflow Obstruction

2019 ◽  
Vol 17 (11) ◽  
pp. 2218-2226.e2 ◽  
Author(s):  
Joseph R. Triggs ◽  
Dustin A. Carlson ◽  
Claire Beveridge ◽  
Anand Jain ◽  
Michael Y. Tye ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
Integrated Relaxation Pressure

scholarly journals Response to multiple rapid swallows shows impaired inhibitory pathways in distal esophageal spasm patients with and without concomitant esophagogastric junction outflow obstruction

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
Patricia V Hernandez ◽  
Luis R Valdovinos ◽  
Jennifer L Horsley-Silva ◽  
Miguel A Valdovinos ◽  
Michael D Crowell ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Botulinum Toxin Injection ◽  
Pneumatic Dilation ◽  
Outflow Obstruction ◽  
Esophageal Body ◽  
Esophageal Spasm ◽  
Inhibitory Pathways ◽  
Healthy Control ◽  
Endoscopic Myotomy ◽  
Integrated Relaxation Pressure

Summary Distal esophageal spasm (DES) is a motility disorder characterized by premature contraction of the esophageal body during single swallows. It is thought to be due to impairment of esophageal inhibitory pathways, but studies to support this are limited. The normal response to multiple rapid swallows (MRS) is deglutitive inhibition of the esophageal body during the MRS sequence. Our aim was to compare the response to MRS in DES patients and healthy control subjects. Response to MRS during HRM was evaluated in 19 DES patients (8 with and 11 without concomitant esophagogastric junction outflow obstruction [EGJOO]) and 24 asymptomatic healthy controls. Patients with prior gastroesophageal surgery, peroral endoscopic myotomy, pneumatic dilation, esophageal botulinum toxin injection within 6 months of HRM, opioid medication use, and esophageal stricture were excluded. Response to MRS was evaluated for complete versus impaired inhibition (esophageal body contractility with distal contractile integral [DCI] > 100 mmHg-sec-cm during MRS), presence of post-MRS contraction augmentation (DCI post MRS greater than single swallow mean DCI), and integrated relaxation pressure (IRP). Impaired deglutitive inhibition during MRS was significantly more frequent in DES compared to controls (89% vs. 0%, P < 0.001), and frequency was similar for DES with versus without concomitant EGJOO (100% vs. 82%, P = 0.48). The proportion of subjects with augmentation post MRS was similar for both groups (37% vs. 38%, P = 1.00), but mean DCI post MRS was higher in DES than controls (3360.0 vs. 1238.9, P = 0.009). IRP was lower during MRS compared to single swallows in all patients, and IRP during MRS was normal in 5 of 8 patients with DES and EGJOO. Our study suggests that impaired deglutitive inhibition during MRS is present in the majority of patients with DES regardless of whether they have concomitant EGJOO, and future studies should explore the usefulness of incorporating response to MRS in the diagnosis of DES.

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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