Look above the IRP: predicting abnormal confirmatory testing in patients with esophagogastric junction outflow obstruction.

BACKGROUND

Esophagogastric junction outflow obstruction (EGJOO) is a manometric diagnosis based on Chicago Classification version 4.0 (CC4.0) that requires confirmatory testing for clinical relevancy. However, it is still unclear which patients will respond to therapy.

OBJECTIVES

To evaluate manometric and clinical predictors of abnormal confirmatory testing for patients with EGJOO.

DESIGN

This was a prospective observational study of patients with manometric EGJOO and chest pain or dysphagia who underwent confirmatory testing.

METHODS

Patients with EGJOO on manometry were enrolled and underwent timed barium esophagram or endoFLIP. A subset of patients was given validated surveys, including Eckardt scores (ES) and PROMIS-10.

RESULTS

For patients with a CC4.0 EGJOO diagnosis, abnormal peristalsis (OR = 7.0, 95% CI = 1.01-44.6, p = 0.04) and increases in ES (OR = 2.34 95% CI = 1.13-4.86, p = 0.02) were associated with positive confirmatory testing.

CONCLUSION

Patients with potentially actionable EGJOO were more likely to have an abnormal peristaltic subtype of EGJOO or higher ES.