High resolution esophageal manometry will show elevated pressure at the LES with normal peristalsis. The LES pressure is evaluated immediately following a swallow, when the sphincter should relax. The overall LES pressure after a swallow is represented by the integrated relaxation pressure (IRP). If the IRP is abnormally elevated (>15 mmHg), this indicates an obstruction is present. Normal peristalsis with an obstruction at the esophagogastric junction (elevated IRP) is consistent with EGJOO.Upper endoscopy is used to evaluate for mechanical causes of obstruction. Endoscopic findings may include a hiatal hernia, esophagitis,  strictures, tumors, or masses. Increased pressure at the LES over time may result in an epiphrenic diverticulum. Further evaluation for mechanical causes of obstruction may include CT scans, MRI, or endoscopic ultrasound.Several additional tests may be used to further evaluate EGJOO. Further evaluation of esophageal motor function may be accomplished with functional lumen imaging probe (FLIP). Although not widely available, FLIP may help assess esophageal wall stiffness and compliance. FLIP may help identify individuals with EGJOO who are likely to benefit from therapeutic procedures.Timed barium esophagram can help distinguish EGJOO from untreated achalasia. Treatment
Treatment primarily consists of addressing the underlying cause of EGJOO. For example, gastroesophageal reflux disease (GERD) with reflux esophagitis is treated with proton pump inhibitors. Esophageal rings or strictures may be treated with esophageal dilation. Simple observation may be considered, especially if symptoms are minimal or absent.
U.S. National Library of Medicine.