Published in:
22-02-2023 | Opioids | Esophagus (K Ravi, Section Editor)
Management of Non-achalasia Esophageal Hypercontractility: EGJ Outflow Obstruction and Hypercontractile Esophagus
Published in: Current Treatment Options in Gastroenterology | Issue 1/2023
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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.