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.
If symptoms are severe or persistent, peroral endoscopic myotomy (POEM) may be offered.Pneumatic dilation may be used for persistent symptoms in the absence of identified causes of mechanical obstruction. Botulinum toxin may be considered, especially for individuals who are unlikely to tolerate surgery. Prognosis
The prognosis for EGJOO depends on the etiology of obstruction. In the absence of anatomic or mechanical causes, such as cancer, outcomes are generally favorable. Individuals with minimal or no symptoms often experience resolution of the EGJOO, even without treatment. Epidemiology
The overall prevalence of EGJOO is unclear. The prevalence of EGJOO among all patients undergoing high resolution manometry was up to 10 percent. The diagnostic criteria were later adjusted to distinguish relevant (symptomatic) EGJOO from isolated manometric findings of EGJOO without symptoms.Individuals diagnosed with EGJOO based on Chicago 3.0 classification have an average age of 56–57 years. EGJOO more commonly affects women (51-88%). The average BMI is between 25 and 30. == References ==