Skip to main content
Erschienen in: Current Treatment Options in Gastroenterology 1/2023

22.02.2023 | Esophagus (K Ravi, Section Editor)

Management of Non-achalasia Esophageal Hypercontractility: EGJ Outflow Obstruction and Hypercontractile Esophagus

verfasst von: Farnoosh Vahedi, MD, Eric E. Low, MD, MPH, Rena Yadlapati, MD, MS

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 1/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

We review and summarize current evidence-based management strategies for non-achalasia esophageal hypercontractility disorders: esophagogastric junction outflow obstruction (EGJOO) and hypercontractile esophagus.

Recent findings

EGJOO. Per Chicago Classifications version 4.0 (CCv4.0), current diagnostic criteria for EGJOO require conclusive manometric findings, clinically relevant symptoms plus at least one supportive test confirming obstruction (either timed barium esophagram (TBE) or functional lumen imaging probe (FLIP)). Hypercontractile esophagus. Per CCv4.0, current diagnostic criteria for hypercontractile esophagus requires conclusive manometric findings in addition to clinically relevant symptoms. Three identifiable sub-groups of hypercontractile esophagus include single-peak hypercontractility, Jackhammer esophagus, and hypercontractile with LES after-contraction.

Summary

Updates in CCv4.0 focus on distinguishing clinically relevant esophageal disorders from manometric patterns alone. As definitive therapies for esophageal disorders are limited, current approaches to treatment focus on achieving symptom relief with conservative modalities prior to attempting more invasive therapies.
Literatur
1.
Zurück zum Zitat Verma A, Misra A, Ghoshal UC. High-resolution esophageal manometry: principles, technique, and interpretation. In: Ghoshal UC, editor. Evaluation of gastrointestinal motility and its disorders. New Delhi: Springer India; 2016. p. 11–22.CrossRef Verma A, Misra A, Ghoshal UC. High-resolution esophageal manometry: principles, technique, and interpretation. In: Ghoshal UC, editor. Evaluation of gastrointestinal motility and its disorders. New Delhi: Springer India; 2016. p. 11–22.CrossRef
2.
Zurück zum Zitat Dodds WJ, Stef JJ, Hogan WJ. Factors determining pressure measurement accuracy by intraluminal esophageal manometry. Gastroenterology. 1976;70(1):117–23.CrossRefPubMed Dodds WJ, Stef JJ, Hogan WJ. Factors determining pressure measurement accuracy by intraluminal esophageal manometry. Gastroenterology. 1976;70(1):117–23.CrossRefPubMed
3.
Zurück zum Zitat Arndorfer RC, Stef JJ, Dodds WJ, Linehan JH, Hogan WJ. Improved infusion system for intraluminal esophageal manometry. Gastroenterology. 1977;73(1):23–7.CrossRefPubMed Arndorfer RC, Stef JJ, Dodds WJ, Linehan JH, Hogan WJ. Improved infusion system for intraluminal esophageal manometry. Gastroenterology. 1977;73(1):23–7.CrossRefPubMed
6.
Zurück zum Zitat Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterology and motility: the official journal of the European Gastrointestinal Motility Society. 2015;27(2):160–74. https://doi.org/10.1111/nmo.12477. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterology and motility: the official journal of the European Gastrointestinal Motility Society. 2015;27(2):160–74. https://​doi.​org/​10.​1111/​nmo.​12477.
7.••
Zurück zum Zitat Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0(©). Neurogastroenterology and motility: the official journal of the European Gastrointestinal Motility Society. 2021;33(1):e14058. https://doi.org/10.1111/nmo.14058. Most recent classification scheme for esophageal motility disorders using metrics from high-resolution manometry from the international working group of fifty-two experts in the field. Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0(©). Neurogastroenterology and motility: the official journal of the European Gastrointestinal Motility Society. 2021;33(1):e14058. https://​doi.​org/​10.​1111/​nmo.​14058. Most recent classification scheme for esophageal motility disorders using metrics from high-resolution manometry from the international working group of fifty-two experts in the field.
10.•
Zurück zum Zitat Visaggi P, Ghisa M, Del Corso G, Baiano Svizzero F, Mariani L, Tolone S, et al. Chicago classification v4.0 protocol improves specificity and accuracy of diagnosis of oesophagogastric junction outflow obstruction. Aliment Pharmacol Ther. 2022;56(4):606–13. https://doi.org/10.1111/apt.17101. Recent study on the role on integrated relaxation pressure during rapid drink challenge for diagnosis of EGJOO. Visaggi P, Ghisa M, Del Corso G, Baiano Svizzero F, Mariani L, Tolone S, et al. Chicago classification v4.0 protocol improves specificity and accuracy of diagnosis of oesophagogastric junction outflow obstruction. Aliment Pharmacol Ther. 2022;56(4):606–13. https://​doi.​org/​10.​1111/​apt.​17101. Recent study on the role on integrated relaxation pressure during rapid drink challenge for diagnosis of EGJOO.
13.
Zurück zum Zitat Babaei A, Szabo A, Shad S, Massey BT. Chronic daily opioid exposure is associated with dysphagia, esophageal outflow obstruction, and disordered peristalsis. Neurogastroenterol Motilit: Off J Eur Gastrointest Motil Soc. 2019;31(7):e13601. https://doi.org/10.1111/nmo.13601.CrossRef Babaei A, Szabo A, Shad S, Massey BT. Chronic daily opioid exposure is associated with dysphagia, esophageal outflow obstruction, and disordered peristalsis. Neurogastroenterol Motilit: Off J Eur Gastrointest Motil Soc. 2019;31(7):e13601. https://​doi.​org/​10.​1111/​nmo.​13601.CrossRef
14.•
Zurück zum Zitat Ratuapli SK, Crowell MD, DiBaise JK, Vela MF, Ramirez FC, Burdick GE, et al. Opioid-induced esophageal dysfunction (OIED) in patients on chronic opioids. Am J Gastroenterol. 2015;110(7):979–84. https://doi.org/10.1038/ajg.2015.154. Retrospective study investigating the role of chronic opioids on esophageal motor disorders. Ratuapli SK, Crowell MD, DiBaise JK, Vela MF, Ramirez FC, Burdick GE, et al. Opioid-induced esophageal dysfunction (OIED) in patients on chronic opioids. Am J Gastroenterol. 2015;110(7):979–84. https://​doi.​org/​10.​1038/​ajg.​2015.​154. Retrospective study investigating the role of chronic opioids on esophageal motor disorders.
15.
Zurück zum Zitat Sanchez MJ, Olivier S, Gediklioglu F, Almeida M, Gaeta M, Nigro M, et al. Chronic opioid use is associated with obstructive and spastic disorders in the esophagus. Neurogastroenterol Motilit: Off J Eur Gastrointest Motil Soc. 2022;34(3):e14233. https://doi.org/10.1111/nmo.14233.CrossRef Sanchez MJ, Olivier S, Gediklioglu F, Almeida M, Gaeta M, Nigro M, et al. Chronic opioid use is associated with obstructive and spastic disorders in the esophagus. Neurogastroenterol Motilit: Off J Eur Gastrointest Motil Soc. 2022;34(3):e14233. https://​doi.​org/​10.​1111/​nmo.​14233.CrossRef
16.
Zurück zum Zitat Schupack D, Katzka DA, Geno DM, Ravi K. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2017;29(10):1–9. https://doi.org/10.1111/nmo.13105.CrossRef Schupack D, Katzka DA, Geno DM, Ravi K. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2017;29(10):1–9. https://​doi.​org/​10.​1111/​nmo.​13105.CrossRef
19.
Zurück zum Zitat Pérez-Fernández MT, Santander C, Marinero A, Burgos-Santamaría D, Chavarría-Herbozo C. Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2016;28(1):116–26. https://doi.org/10.1111/nmo.12708.CrossRef Pérez-Fernández MT, Santander C, Marinero A, Burgos-Santamaría D, Chavarría-Herbozo C. Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2016;28(1):116–26. https://​doi.​org/​10.​1111/​nmo.​12708.CrossRef
22.
Zurück zum Zitat J Rajan, FRCA, J Scott-Warren, DRCOG MRCP FRCA FFPMRCA, The clinical use of methadone in cancer and chronic pain medicine, BJA Ed. 2016;16(3):102–106. J Rajan, FRCA, J Scott-Warren, DRCOG MRCP FRCA FFPMRCA, The clinical use of methadone in cancer and chronic pain medicine, BJA Ed. 2016;16(3):102–106.
24.
Zurück zum Zitat Beveridge C, Lynch K. Diagnosis and management of esophagogastric junction outflow obstruction. Gastroenterol Hep. 2020;16(3):131–8. Beveridge C, Lynch K. Diagnosis and management of esophagogastric junction outflow obstruction. Gastroenterol Hep. 2020;16(3):131–8.
25.
26.
Zurück zum Zitat Beveridge CA, Triggs JR, Thanawala SU, Ahuja NK, Falk GW, Benitez AJ, et al. Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction? Dis Esophagus: Off J Int Soc Dis Esophagus. 2022;35(4). https://doi.org/10.1093/dote/doab077. Beveridge CA, Triggs JR, Thanawala SU, Ahuja NK, Falk GW, Benitez AJ, et al. Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction? Dis Esophagus: Off J Int Soc Dis Esophagus. 2022;35(4). https://​doi.​org/​10.​1093/​dote/​doab077.
28.•
Zurück zum Zitat Clayton SB, Shin CM, Ewing A, Blonski W, Richter J. Pneumatic dilation improves esophageal emptying and symptoms in patients with idiopathic esophago-gastric junction outflow obstruction. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2019;31(3):e13522. https://doi.org/10.1111/nmo.13522. Study looking at the utility of PD in treatment of EGJOO.CrossRef Clayton SB, Shin CM, Ewing A, Blonski W, Richter J. Pneumatic dilation improves esophageal emptying and symptoms in patients with idiopathic esophago-gastric junction outflow obstruction. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2019;31(3):e13522. https://​doi.​org/​10.​1111/​nmo.​13522. Study looking at the utility of PD in treatment of EGJOO.CrossRef
33.
34.
Zurück zum Zitat Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg. 2018;267(3):451–60.CrossRefPubMed Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg. 2018;267(3):451–60.CrossRefPubMed
35.
Zurück zum Zitat Hasan A, Low EE, Fehmi SA, Yadlapati R. Evolution and evidence-based adaptations in techniques for peroral endoscopic myotomy for achalasia. Gastrointest Endosc. 2022;96(2):189–96.CrossRefPubMedPubMedCentral Hasan A, Low EE, Fehmi SA, Yadlapati R. Evolution and evidence-based adaptations in techniques for peroral endoscopic myotomy for achalasia. Gastrointest Endosc. 2022;96(2):189–96.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Wahba G, Bouin M. Jackhammer esophagus: a meta-analysis of patient demographics, disease presentation, high-resolution manometry data, and treatment outcomes. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2020;32(11):e13870. https://doi.org/10.1111/nmo.13870.CrossRef Wahba G, Bouin M. Jackhammer esophagus: a meta-analysis of patient demographics, disease presentation, high-resolution manometry data, and treatment outcomes. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2020;32(11):e13870. https://​doi.​org/​10.​1111/​nmo.​13870.CrossRef
41.
Zurück zum Zitat Al-Qaisi MT, Siddiki HA, Crowell MD, Burdick GE, Fleischer DE, Ramirez FC, et al. The clinical significance of hypercontractile peristalsis: comparison of high-resolution manometric features, demographics, symptom presentation, and response to therapy in patients with Jackhammer esophagus versus Nutcracker esophagus. Dis Esophagus: Off J Int Soc Dis Esophagus. 2017;30(12):1–7. https://doi.org/10.1093/dote/dox085.CrossRef Al-Qaisi MT, Siddiki HA, Crowell MD, Burdick GE, Fleischer DE, Ramirez FC, et al. The clinical significance of hypercontractile peristalsis: comparison of high-resolution manometric features, demographics, symptom presentation, and response to therapy in patients with Jackhammer esophagus versus Nutcracker esophagus. Dis Esophagus: Off J Int Soc Dis Esophagus. 2017;30(12):1–7. https://​doi.​org/​10.​1093/​dote/​dox085.CrossRef
42.
Zurück zum Zitat Chen JW, Savarino E, Smout A, Xiao Y, de Bortoli N, Yadlapati R, et al. Chicago Classification update (v4.0): technical review on diagnostic criteria for hypercontractile esophagus. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2021;33(6):e14115. https://doi.org/10.1111/nmo.14115.CrossRef Chen JW, Savarino E, Smout A, Xiao Y, de Bortoli N, Yadlapati R, et al. Chicago Classification update (v4.0): technical review on diagnostic criteria for hypercontractile esophagus. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. 2021;33(6):e14115. https://​doi.​org/​10.​1111/​nmo.​14115.CrossRef
43.
46.
Metadaten
Titel
Management of Non-achalasia Esophageal Hypercontractility: EGJ Outflow Obstruction and Hypercontractile Esophagus
verfasst von
Farnoosh Vahedi, MD
Eric E. Low, MD, MPH
Rena Yadlapati, MD, MS
Publikationsdatum
22.02.2023
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 1/2023
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-023-00410-8

Weitere Artikel der Ausgabe 1/2023

Current Treatment Options in Gastroenterology 1/2023 Zur Ausgabe

Esophagus (K Ravi, Section Editor)

Management of Esophageal Diverticula

Nutrition and Obesity (C Newberry, Section Editor)

The Role of the Gastroenterologist in Modern Nutrition Support Services

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Battle of Experts: Sport vs. Spritze bei Adipositas und Typ-2-Diabetes

11.05.2024 DDG-Jahrestagung 2024 Kongressbericht

Im Battle of Experts traten zwei Experten auf dem Diabeteskongress gegeneinander an: Die eine vertrat die Auffassung „Sport statt Spritze“ bei Adipositas und Typ-2-Diabetes, der andere forderte „Spritze statt Sport!“ Am Ende waren sie sich aber einig: Die Kombination aus beidem erzielt die besten Ergebnisse.

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Triglyzeridsenker schützt nicht nur Hochrisikopatienten

10.05.2024 Hypercholesterinämie Nachrichten

Patienten mit Arteriosklerose-bedingten kardiovaskulären Erkrankungen, die trotz Statineinnahme zu hohe Triglyzeridspiegel haben, profitieren von einer Behandlung mit Icosapent-Ethyl, und zwar unabhängig vom individuellen Risikoprofil.

Gibt es eine Wende bei den bioresorbierbaren Gefäßstützen?

In den USA ist erstmals eine bioresorbierbare Gefäßstütze – auch Scaffold genannt – zur Rekanalisation infrapoplitealer Arterien bei schwerer PAVK zugelassen worden. Das markiert einen Wendepunkt in der Geschichte dieser speziellen Gefäßstützen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.