Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?
Abstract Background Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional...
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| Veröffentlicht in: | Diseases of the esophagus 2022-04, Vol.35 (4) |
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| creator | Beveridge, Claire A Triggs, Joseph R Thanawala, Shivani U Ahuja, Nitin K Falk, Gary W Benitez, Alain J Lynch, Kristle L |
| description | Abstract
Background
Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment.
Methods
A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations.
Results
Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03.
Conclusion
This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO. |
| doi_str_mv | 10.1093/dote/doab077 |
| format | Article |
| fullrecord | <record><control><sourceid>oup_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9016893</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/dote/doab077</oup_id><sourcerecordid>10.1093/dote/doab077</sourcerecordid><originalsourceid>FETCH-LOGICAL-c416t-6779b3ddd1df65438cb887ab8315e52cf8dccabf2f62af9f53230426cbb77b093</originalsourceid><addsrcrecordid>eNp9UMtKw0AUHUSxtbpzLdm5MTqPZGayUaRYLRQU0XWYZzqlzYRkovTvndpadOPmvs6553IPAOcIXiNYkBvtg4lBSMjYARiiLMMphjk8jDXCMOW0yAbgpOsWECJGKD8GA5JxmhWYD8HrWNTJZDZ9SareaZOEuWlFs05cnTjtfCPC3KnEdL6Zi8pXogtt7Bd9rYLzdeL7YJf-M_EyAv337O4UHFmx7MzZLo_A--ThbfyUzp4fp-P7WaoyRENKGSsk0VojbWmeEa4k50xITlBucqws10oJabGlWNjC5gQTmGGqpGRMxs9H4Har2_RyZbQydWjFsmxatxLtuvTClX-R2s3Lyn-UBUSUFyQKXG0FVOu7rjV2v4tgufG23Hhb7ryN9Ivf9_bkHzMj4XJL8H3zv9QXvCuHWQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Beveridge, Claire A ; Triggs, Joseph R ; Thanawala, Shivani U ; Ahuja, Nitin K ; Falk, Gary W ; Benitez, Alain J ; Lynch, Kristle L</creator><creatorcontrib>Beveridge, Claire A ; Triggs, Joseph R ; Thanawala, Shivani U ; Ahuja, Nitin K ; Falk, Gary W ; Benitez, Alain J ; Lynch, Kristle L</creatorcontrib><description>Abstract
Background
Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment.
Methods
A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations.
Results
Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03.
Conclusion
This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.</description><identifier>ISSN: 1120-8694</identifier><identifier>EISSN: 1442-2050</identifier><identifier>DOI: 10.1093/dote/doab077</identifier><identifier>PMID: 34864928</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adult ; Botulinum Toxins ; Deglutition Disorders ; Esophageal Achalasia ; Esophageal Motility Disorders - diagnosis ; Esophagogastric Junction ; Humans ; Manometry - methods ; Original ; Prospective Studies ; Stomach Diseases - complications</subject><ispartof>Diseases of the esophagus, 2022-04, Vol.35 (4)</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-6779b3ddd1df65438cb887ab8315e52cf8dccabf2f62af9f53230426cbb77b093</citedby><cites>FETCH-LOGICAL-c416t-6779b3ddd1df65438cb887ab8315e52cf8dccabf2f62af9f53230426cbb77b093</cites><orcidid>0000-0002-1835-1381</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34864928$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Beveridge, Claire A</creatorcontrib><creatorcontrib>Triggs, Joseph R</creatorcontrib><creatorcontrib>Thanawala, Shivani U</creatorcontrib><creatorcontrib>Ahuja, Nitin K</creatorcontrib><creatorcontrib>Falk, Gary W</creatorcontrib><creatorcontrib>Benitez, Alain J</creatorcontrib><creatorcontrib>Lynch, Kristle L</creatorcontrib><title>Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?</title><title>Diseases of the esophagus</title><addtitle>Dis Esophagus</addtitle><description>Abstract
Background
Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment.
Methods
A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations.
Results
Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03.
Conclusion
This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.</description><subject>Adult</subject><subject>Botulinum Toxins</subject><subject>Deglutition Disorders</subject><subject>Esophageal Achalasia</subject><subject>Esophageal Motility Disorders - diagnosis</subject><subject>Esophagogastric Junction</subject><subject>Humans</subject><subject>Manometry - methods</subject><subject>Original</subject><subject>Prospective Studies</subject><subject>Stomach Diseases - complications</subject><issn>1120-8694</issn><issn>1442-2050</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UMtKw0AUHUSxtbpzLdm5MTqPZGayUaRYLRQU0XWYZzqlzYRkovTvndpadOPmvs6553IPAOcIXiNYkBvtg4lBSMjYARiiLMMphjk8jDXCMOW0yAbgpOsWECJGKD8GA5JxmhWYD8HrWNTJZDZ9SareaZOEuWlFs05cnTjtfCPC3KnEdL6Zi8pXogtt7Bd9rYLzdeL7YJf-M_EyAv337O4UHFmx7MzZLo_A--ThbfyUzp4fp-P7WaoyRENKGSsk0VojbWmeEa4k50xITlBucqws10oJabGlWNjC5gQTmGGqpGRMxs9H4Har2_RyZbQydWjFsmxatxLtuvTClX-R2s3Lyn-UBUSUFyQKXG0FVOu7rjV2v4tgufG23Hhb7ryN9Ivf9_bkHzMj4XJL8H3zv9QXvCuHWQ</recordid><startdate>20220419</startdate><enddate>20220419</enddate><creator>Beveridge, Claire A</creator><creator>Triggs, Joseph R</creator><creator>Thanawala, Shivani U</creator><creator>Ahuja, Nitin K</creator><creator>Falk, Gary W</creator><creator>Benitez, Alain J</creator><creator>Lynch, Kristle L</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1835-1381</orcidid></search><sort><creationdate>20220419</creationdate><title>Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?</title><author>Beveridge, Claire A ; Triggs, Joseph R ; Thanawala, Shivani U ; Ahuja, Nitin K ; Falk, Gary W ; Benitez, Alain J ; Lynch, Kristle L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-6779b3ddd1df65438cb887ab8315e52cf8dccabf2f62af9f53230426cbb77b093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Botulinum Toxins</topic><topic>Deglutition Disorders</topic><topic>Esophageal Achalasia</topic><topic>Esophageal Motility Disorders - diagnosis</topic><topic>Esophagogastric Junction</topic><topic>Humans</topic><topic>Manometry - methods</topic><topic>Original</topic><topic>Prospective Studies</topic><topic>Stomach Diseases - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beveridge, Claire A</creatorcontrib><creatorcontrib>Triggs, Joseph R</creatorcontrib><creatorcontrib>Thanawala, Shivani U</creatorcontrib><creatorcontrib>Ahuja, Nitin K</creatorcontrib><creatorcontrib>Falk, Gary W</creatorcontrib><creatorcontrib>Benitez, Alain J</creatorcontrib><creatorcontrib>Lynch, Kristle L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diseases of the esophagus</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beveridge, Claire A</au><au>Triggs, Joseph R</au><au>Thanawala, Shivani U</au><au>Ahuja, Nitin K</au><au>Falk, Gary W</au><au>Benitez, Alain J</au><au>Lynch, Kristle L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?</atitle><jtitle>Diseases of the esophagus</jtitle><addtitle>Dis Esophagus</addtitle><date>2022-04-19</date><risdate>2022</risdate><volume>35</volume><issue>4</issue><issn>1120-8694</issn><eissn>1442-2050</eissn><abstract>Abstract
Background
Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment.
Methods
A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations.
Results
Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03.
Conclusion
This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>34864928</pmid><doi>10.1093/dote/doab077</doi><orcidid>https://orcid.org/0000-0002-1835-1381</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Diseases of the esophagus, 2022-04, Vol.35 (4) |
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| language | eng |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Adult Botulinum Toxins Deglutition Disorders Esophageal Achalasia Esophageal Motility Disorders - diagnosis Esophagogastric Junction Humans Manometry - methods Original Prospective Studies Stomach Diseases - complications |
| title | Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction? |
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