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Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review.

Publication ,  Conference
Garbarino, S; von Isenburg, M; Fisher, DA; Leiman, DA
Published in: J Clin Gastroenterol
January 2020

GOALS: Awareness of functional esophagogastric junction outflow obstruction (fEGJOO) has increased, but because there is no consensus on its management, we performed a systematic review of the literature to explore treatment strategies and outcomes. BACKGROUND: EGJOO is a heterogenous disorder defined by high-resolution manometry parameters of elevated integrated relaxation pressure with preserved esophageal peristalsis. The etiology may be mechanical obstruction or idiopathic, the latter being fEGJOO. STUDY: The PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through June 2018 for all studies of adult patients describing a treatment strategy for fEGJOO or incomplete lower esophageal sphincter relaxation. The search strategy yielded 1792 studies and 8 (0.4%) met inclusion criteria. RESULTS: All but one included studies were retrospective (n=184 patients). There were 5 interventions described, with botulinum toxin (Botox) injection (n=69) and expectant management (n=82) the most frequently reported, with success rates of 58% and 54%, respectively. There was substantial heterogeneity among patients and treatments were not directly compared, though reported symptom resolution was similar among all strategies with a mean follow-up time of 15 months. CONCLUSIONS: There are a variety of management strategies available for fEGJOO and some patients may not require any intervention. However, among 4 potential approaches aimed at disrupting lower esophageal sphincter hypertonicity, the largest existing evidence base supports either a therapeutic challenge of Botox injection or watchful waiting. Ultimately, these data indicate the need for further study with controlled trials to identify a definitive approach.

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Published In

J Clin Gastroenterol

DOI

EISSN

1539-2031

Publication Date

January 2020

Volume

54

Issue

1

Start / End Page

35 / 42

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Treatment Outcome
  • Retrospective Studies
  • Prospective Studies
  • Male
  • Injections, Intramuscular
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophagogastric Junction
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Garbarino, S., von Isenburg, M., Fisher, D. A., & Leiman, D. A. (2020). Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review. In J Clin Gastroenterol (Vol. 54, pp. 35–42). United States. https://doi.org/10.1097/MCG.0000000000001156
Garbarino, Stephanie, Megan von Isenburg, Deborah A. Fisher, and David A. Leiman. “Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review.” In J Clin Gastroenterol, 54:35–42, 2020. https://doi.org/10.1097/MCG.0000000000001156.
Garbarino S, von Isenburg M, Fisher DA, Leiman DA. Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review. In: J Clin Gastroenterol. 2020. p. 35–42.
Garbarino, Stephanie, et al. “Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review.J Clin Gastroenterol, vol. 54, no. 1, 2020, pp. 35–42. Pubmed, doi:10.1097/MCG.0000000000001156.
Garbarino S, von Isenburg M, Fisher DA, Leiman DA. Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review. J Clin Gastroenterol. 2020. p. 35–42.

Published In

J Clin Gastroenterol

DOI

EISSN

1539-2031

Publication Date

January 2020

Volume

54

Issue

1

Start / End Page

35 / 42

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Treatment Outcome
  • Retrospective Studies
  • Prospective Studies
  • Male
  • Injections, Intramuscular
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophagogastric Junction