Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by increased pressure where the esophagus connects to the stomach at the lower esophageal sphincter. EGJOO is diagnosed by esophageal manometry. However, EGJOO has a variety of etiologies; evaluating the cause of obstruction with additional testing, such as upper endoscopy, computed tomography (CT imaging), or endoscopic ultrasound may be necessary. When possible, treatment of EGJOO should be directed at the cause of obstruction. When no cause for obstruction is found (functional EGJOO), observation alone may be considered if symptoms are minimal. Functional EGJOO with significant or refractor symptoms may be treated with pneumatic dilation, per-oral endoscopic myotomy (POEM), or botulinum toxin injection. Types
EGJOO may be broadly categorized into 4 subgroups: mechanical, functional, medication-related, and artifact. Signs and symptoms
In some cases, EGJOO may cause no symptoms, and the manometry findings are identified during an evaluation prior to anti-reflux surgery. In other cases, EGJOO may be identified after an evaluation for esophageal symptoms. The most common symptoms are dysphagia (50-75%, typical reflux (29-67%), atypical reflux (21-36%), chest pain (16-46%), abdominal pain (43%) or regurgitation (38%). One study suggested about 5% of individuals have no symptoms. Causes
Several causes for EGJOO exist. Etiologies include early achalasia, mechanical processes (eosinophilic esophagitis, hiatal hernia, strictures, etc. ), esophageal wall thickness (fibrosis, cancer, etc. ), compression by nearby blood vessels (external vascular compression), obesity, opioid medication effect, or anatomic abnormalities. The findings associated with EGJOO may be falsely abnormal due to measurement errors. Diagnosis
EGJOO is diagnosed using esophageal manometry.
It has been found to be beneficial for the treatment of navicular syndrome, laminitis, and osteoarthritis, in some cases having a more profound effect than the commonly used NSAID phenylbutazone. However, due to cost, it is not routinely used in practice. Toxicity due to excessive dosage is similar to that of phenylbutazone, including depression, anorexia, weight loss, edema, diarrhea, oral ulceration, and decreased hematocrit. == References ==