Clinical features and esophageal motility characteristics of patients with esophagogastric junction outflow obstruction

Abstract

Objective To analyze the clinical features and esophageal motility characteristics of patients with esophagogastric junction outflow obstruction (EGJOO). Methods From January 2015 to January 2018, at Affiliated Hospital of Zunyi Medical College, the clinical data of 663 outpatients with various gastrointestinal symptoms were collected. Gastroscopy and esophageal high resolution manometry (HRM) were performed to exclude gastrointestinal organic lesions. The 120 patients were divided into EGJOO group (71 cases) and non-EGJOO group (49 cases). Furthermore, according to integrated relaxation pressure (IRP) the 71 EGJOO patients were divided into mild group (41 cases), moderate group (20 cases) and severe group (10 cases). Independent sample t test and one-way analysis of variance were performed for statistical analysis. Results Among 71 EGJOO patients, 43.7% (31/71) showed post sternal heartburn or acid regurgitation, 32.4% (23/71) showed obstruction or dysphagia, 21.1% (15/71) showed chest pain, 21.1% (15/71) showed other atypical symptoms such as hiccups and bloating, and 5.6% (4/71) showed upper abdominal pain. The IRP, lower esophageal sphincter (LES) length, LES resting pressure and intrabolus pressure (IBP) of the EGJOO group were higher than those of the non-EGJOO group ((18.24±3.07) mmHg (1 mmHg=0.133 kPa) vs. (10.92±2.37) mmHg, (3.47±0.85) cm vs. (3.11±0.80) cm, (32.33±9.11) mmHg vs. (21.31±6.55) mmHg, (6.22±3.74) mmHg vs. (4.69±2.68) mmHg), and the differences were statistically significant (t=-13.947, -2.303, -7.706 and -2.626; all P<0.05). The LES relaxation rate and distal contractile integral (DCI) of the EGJOO group were lower than those of the non-EGJOO group ((44.03±9.86)% vs. (53.86±11.33)%, (1 410.13±794.23) mmHg·s·cm vs. (1 741.86±894.16) mmHg·s·cm), and the differences were statistically significant (t=5.046 and 2.136, both P<0.05). The LES resting pressure of the mild group was higher than that of the moderate group ((30.76±9.23) mmHg vs. (29.69±5.87) mmHg); the LES resting pressure of the moderate group was lower than that of the severe group ((29.69±5.87) mmHg vs. (42.02±9.23) mmHg); and the differences were statistically significant (both Tamhane test, P=0.012 and 0.011). The IBP of the mild group was lower than that of the moderate group and the severe group ((5.16±3.41) mmHg vs. (8.02±2.58) mmHg and (7.46±3.48) mmHg), and the differences were statistically significant (both least-significant difference test, both P<0.05). The DCI of the mild group was lower than that of the moderate group ((1 241.41±606.12) mmHg·s·cm vs. (1 438.55±644.74) mmHg·s·cm), and the difference was statistically significant (Tamhane test, P=0.011). Conclusions Heartburn, acid reflux and dysphagia are common clinical symptoms in EGJOO patients. The weaker the peristalsis of the esophageal body of EGJOO patients, the more obvious of dysphagia. Increased IBP is an indirect manifestation of esophagogastric junction relaxation disorder. Key words: Esophagogastric junction outflow obstruction; Esophageal motility; Clinical characteristics; High resolution manometry