S0357 Differences in Clinical Features and Treatment Outcomes Between Patients With Dysphagia-Predominant and Chest Pain-Predominant Esophagogastric Junction Outflow Obstruction (EGJOO)

Abstract

INTRODUCTION: Esophagogastric junction outflow obstruction (EGJOO) is the condition in which high-resolution manometry reveals elevated integrated relaxation pressure (IRP) with some preserved peristalsis. EGJOO may be an achalasia variant, a manifestation of disorders that infiltrate or push on the esophagus, or a spurious finding. Dysphagia and/or chest pain are the typical symptoms of EGJOO, and it is not clear how presenting symptoms relate to other features of the condition. We aimed to compare clinical features, manometric findings, and treatment outcomes between EGJOO patients with dysphagia-predominant (DP) vs. chest pain-predominant (CPP) symptoms. METHODS: We searched our manometry database for patients with a diagnosis of EGJOO, and excluded those with a structural cause for EGJOO or prior foregut surgery. We collected demographic data and manometric data including median IRP, distal contractile integral (DCI), and distal latency (DL). Symptoms were evaluated using the Eckardt score and Brief Esophageal Dysphagia Questionnaire (BEDQ), both of which are obtained routinely in patients seen in our Center for Esophageal Diseases. Patients were categorized as DP or CPP based on whichever score (dysphagia or chest pain) was higher on the Eckardt questionnaire. Medical records were reviewed for treatments and response. RESULTS: Among 187 patients with EGJOO, 101 were excluded for intrinsic esophageal pathology, extrinsic esophageal compression, or prior foregut surgery. Among 86 patients with idiopathic EGJOO, 31 were DP and 13 were CPP; 23 were excluded because dysphagia and chest pain scores were equal, and 19 had neither dysphagia nor chest pain. DP patients were older (63.5 vs 45.9 years, P < 0.05) and more likely to be female (65% vs 54%, P = 0.5) than CPP patients. The groups were similar in total Eckardt score (4 in both groups) and BEDQ score (12 DP vs 11 CPP, P = 0.8). The median IRP (22.1 DP vs 20.9 CPP mmHg, P = 0.6) and mean DL (6.7 DP vs 6.2 CPP seconds, P = 0.5) were similar, but the mean DCI was higher in the DP group (3256 DP vs 1534 CPP mmHg-cm-sec, P = 0.4). DP patients were more likely to respond to balloon dilation (the most frequently used treatment) than CPP patients (42% vs 0%, P < 0.05), and were more likely to report symptom improvement on follow up than CPP patients (29% vs 3%, P = 0.05). CONCLUSION: Compared to CPP patients, DP patients with EGJOO were older and predominantly female. DP patients had a significantly higher mean DCI and better response to treatment than CPP patients.