Details

Autor(en) / Beteiligte

• Carlson, Dustin A
• Yadlapati, Rena
• Pandolfino, John E

Titel

The Tailored Approach to Manometric Esophagogastric Junction Outflow Obstruction: Treat the Clinical Diagnosis, Not the Manometry Pattern

Ist Teil von

• The American journal of gastroenterology, 2023-01, Vol.118 (1), p.5-9

Ort / Verlag

United States: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• Updated HRM criteria for EGJOO include an elevated median integrated relaxation pressure (IRP; a measure of EGJ relaxation pressure) in both supine and upright HRM positions (compared with the reliance on an elevated IRP in a single position from previous CC versions), intrabolus pressurization in at least 20% of supine test swallows, and the presence of appreciable peristalsis such that a diagnosis for achalasia is not achieved (Figures 1 and 2; Table 2). See PDF] Also notable is that CC is intended for the evaluation of nonobstructive dysphagia and to diagnose a primary esophageal motility disorder and, thus, applicable to patients with normal esophageal anatomy and without previous foregut surgery, large hiatal hernia, paraesophageal hernia, or overt mechanical obstruction (Table 1). In the case that complementary testing yields supportive (but not conclusive) findings for EGJ obstruction (Table 3) and even in some cases of conclusive complementary findings, distinguishing between achalasia variant and other etiologies for the EGJ obstruction (such as subtle mechanical obstruction) can pose a challenge. [...]treatment strategies generally involve a graded, step-up approach initially using less invasive and reversible options before pursuing definitive (irreversible) achalasia-type treatments (Figure 3). See PDF] When consistent abnormal findings are observed on complementary testing such that the global clinical impression (i.e., also incorporating clinical history and course, endoscopy findings, and additional HRM features) is of achalasia, treatment with pneumatic dilation, peroral endoscopic myotomy, or laparoscopic Heller myotomy may be considered for definitive treatment, tailored to the clinical impression.