Esophagogastric Junction Outflow Obstruction
In addition to the 3 subtypes of achalasia, CC v3.0 recognizes EGJ outflow obstruction as another entity characterized by EGJ obstructive physiology. With this entity, the IRP is greater than the upper limit of normal, but there is fragmented or even normal peristalsis such that criteria for achalasia are not met. From its initial description, EGJ outflow obstruction was reported to be a heterogeneous group, only some of whom benefitted from achalasia treatments. Potential etiologies include incompletely expressed or early achalasia, esophageal wall stiffness from an infiltrative disease or cancer, eosinophilic esophagitis, extrinsic vascular obstruction, sliding or paraesophageal hiatal hernia, abdominal obesity, opiate effect, or simply a false-positive measurement. Consequently, further clinical evaluation (eg, endoscopic ultrasound, FLIP, computed tomography) and a cautious approach to treatment are requisite. Indeed, 4 recent series of EGJ outflow obstruction found many cases that were minimally symptomatic or asymptomatic and that the condition resolved spontaneously 20%–40% of the time.[46–49] Nonetheless, 12%–40% of them ended up being treated as achalasia, albeit conservatively.
Clin Gastroenterol Hepatol. 2018;16(11):1692-1700. © 2018 AGA Institute