Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2022; 28(30): 4163-4173
Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4163
Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates
Yue-Yuan Li, Wen-Ting Lu, Jian-Xiang Liu, Li-Hong Wu, Meng Chen, Hong-Mei Jiao
Yue-Yuan Li, Wen-Ting Lu, Meng Chen, Hong-Mei Jiao, Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
Jian-Xiang Liu, Li-Hong Wu, Department of Gastroenterology and Hepatology, Peking University First Hospital, Beijing 100034, China
Author contributions: Li YY and Lu WT contributed equally to this work; Li YY, Lu WT, and Jiao HM conception and designed of research; Li YY and Lu WT analyzed data; Lu WT and Chen M performed the HRM and provided clinical information; Li YY, Liu JX, and Jiao HM interpreted of research; Li YY drafted manuscript; Jiao HM revised manuscript and approved the final version of manuscript; all authors approved the final version of the article.
Supported by the China Central Health Research Fund, No. W2013BJ29; and the Interdisciplinary Clinical Research Project of Peking University First Hospital, No.2019CR40.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Peking University First Hospital, No. 2022-099.
Informed consent statement: A waiver of informed consent was granted by our Institutional Review Board because our retrospective analysis used completely anonymized data.
Conflict-of-interest statement: All authors have declared no conflicts of interest.
Data sharing statement: Data sharing available, please require through email.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hong-Mei Jiao, MD, Chief Physician, Department of Geriatrics, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
Received: March 10, 2022
Peer-review started: March 10, 2022
First decision: April 11, 2022
Revised: April 21, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 14, 2022
Processing time: 152 Days and 16.5 Hours
Research background

The critical diagnostic criteria for esophagogastric junction outflow obstruction (EGJOO) were published in the latest Chicago Classification version 4.0 (CCv4.0). However, as a result of the diagnostic criteria modifications, the changes in manometric features of EGJOO remained unclear.

Research motivation

To investigate the changes of EGJOO manometric features according to the Chicago Classification updates.

Research objectives

This study focused on evaluating the esophageal motility characteristics of patients with EGJOO, and selecting valuable parameters that are supportive for confirming the diagnosis of EGJOO.

Research methods

A total of 97 patients were enrolled, with 24 patients that met the updated manometric diagnosis of EGJOO (CCv4.0), 27 patients that only met the previous criteria, and 46 patients with normal manometric features served as the normal high-resolution manometry (HRM) group for this study. We collected clinical data, HRM parameters, and conducted comparisons among groups. Factors associated with EGJOO were illustrated by multivariate analysis. Furthermore, valuable parameters that strengthen the confidence in an EGJOO diagnosis were selected by the receiver-operating characteristic analysis.

Research results

EGJOO patients revealed significantly decreased proximal esophageal contractile integral (PECI) and proximal esophageal length (PEL) compared to the normal HRM group, and the features were related to dysphagia. EGJOO patients also had more severe dysfunction of the esophagogastric junction including lower esophageal sphincter resting pressure (LESP), intrabolus pressure, median supine integrated relaxation pressure (IRP), median upright IRP, and IRP on rapid drink challenge (RDC) than patients that only met the previous criteria. Further multivariate analysis revealed that the PEL, LESP, and IRP on RDC are factors associated with EGJOO. Additionally, the upper esophageal sphincter nadir pressure, PECI, PEL, LESP, and IRP on RDC contributes to confirming the diagnosis of EGJOO.

Research conclusions

The updates of Chicago Classification have improved the precision for identification of EGJ dysfunction that may reduce over-diagnosing for EGJOO. The motility disorder of EGJOO is implicated in the proximal esophagus, and the changes of proximal esophagus may relate to dysphagia. Additionally, there are valuable parameters that can be applied for confirming the diagnosis of EGJOO.

Research perspectives

Further investigations are required to reveal the pathophysiological mechanism of the abnormal proximal esophageal motility showed in EGJOO patients, and larger cohorts are required to explore the prognostic value of the parameters mentioned above.