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Esophageal anatomy and physiology vary across spastic and non‐spastic phenotypes of disorders of esophagogastric junction outflow

Vahedi, Farnoosh ; Low, Eric E. ; Kaizer, Alexander M. ; Fehmi, Syed Abbas ; Hasan, Aws ; Chang, Michael A. ; Kwong, Wilson ; Krinsky, Mary L. ; Anand, Gobind ; Greytak, Madeline ; Yadlapati, Rena

Neurogastroenterology and motility, 2024-02, Vol.36 (2), p.e14709-n/a [Periódico revisado por pares]

England

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  • Título:
    Esophageal anatomy and physiology vary across spastic and non‐spastic phenotypes of disorders of esophagogastric junction outflow
  • Autor: Vahedi, Farnoosh ; Low, Eric E. ; Kaizer, Alexander M. ; Fehmi, Syed Abbas ; Hasan, Aws ; Chang, Michael A. ; Kwong, Wilson ; Krinsky, Mary L. ; Anand, Gobind ; Greytak, Madeline ; Yadlapati, Rena
  • Assuntos: Adult ; dysphagia ; esophageal ; Esophageal Achalasia ; Esophageal Motility Disorders ; Esophagogastric Junction ; Female ; Humans ; Male ; management ; Manometry - methods ; Middle Aged ; motility ; Muscle Spasticity ; non‐achalasia disorders ; outcomes ; physiology ; Retrospective Studies ; treatment
  • É parte de: Neurogastroenterology and motility, 2024-02, Vol.36 (2), p.e14709-n/a
  • Notas: Farnoosh Vahedi and Eric E. Low are co‐primary authorship.
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  • Descrição: Background Pathophysiologic mechanisms of disorders of esophagogastric junction (EGJ) outflow are poorly understood. We aimed to compare anatomic and physiologic characteristics among patients with disorders of EGJ outflow and normal motility. Methods We retrospectively evaluated adult patients with achalasia types 1, 2, 3, EGJ outflow obstruction (EGJOO) or normal motility on high‐resolution manometry who underwent endoscopic ultrasound (EUS) from January 2019 to August 2022. Thickened circular muscle was defined as ≥1.6 mm. Characteristics from barium esophagram (BE) and functional lumen imaging probe (FLIP) were additionally assessed. Key Results Of 71 patients (mean age 56.2 years; 49% male), there were 8 (11%) normal motility, 58 (82%) had achalasia (5 (7%) type 1, 32 (45%) classic type 2, 21 (30%) type 3 [including 12 type 2 with FEPs]), and 7 (7%) had EGJOO. A significantly greater proportion of type 3 achalasia had thickened distal circular muscle (76.2%) versus normal motility (0%; p < 0.001) or type 2 achalasia (25%; p < 0.001). Type 1 achalasia had significantly wider mean maximum esophageal diameter on BE (57.8 mm) compared to type 2 achalasia (32.8 mm), type 3 achalasia (23.4 mm), EGJOO (15.9 mm), and normal motility (13.5 mm). 100% type 3 achalasia versus 0% type 1 achalasia/normal motility had tertiary contractions on BE. Mean EGJ distensibility index on FLIP was lower for type 3 achalasia (1.2 mmHg/mm2) and EGJOO (1.2 mmHg/mm2) versus type 2 (2.3 mmHg/mm2) and type 1 achalasia (2.9 mmHg/mm2). Conclusions Our findings suggest distinct pathologic pathways may exist: type 3 achalasia and EGJOO may represent a spastic outflow phenotype consisting of a thickened, spastic circular muscle, which is distinct from type 1 and 2 achalasia consisting of a thin caliber circular muscle layer with more prominent esophageal dilation. The findings of our study suggest anatomical and physiologic patterns that may reflect a distinct pathological pathway for disorders of EGJ outflow. Our findings, moreover, underscore the need for prospective studies with rigorous physiologic testing to explore the natural history of disorders of EGJ outflow and inform management and therapeutics.
  • Editor: England
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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