Introduction
Upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. One of its main functions is to prevent esophago-pharyngeal reflux; however, it also plays a key role during swallowing, belching, and vomiting. Data on UES involvement on pathogenesis and clinical manifestations of esophagogastric junction outflow obstruction (EGJOO) are lacking.
Aims & Methods
Aim of this study the UES manometric parameters analysis and study of their impact on pathogenesis and clinical presentation of patients affected by Esophagogastric Junction Outflow Obstruction (EGJOO) according to the Chicago Classification v4.0 criteria. Manometric tracings, epidemiological and clinical data of patients with a diagnosis of EGJOO in our departments between 07/2021- 03/2025 were analyzed. Clinical presentation was evaluated by performing Dysphagia Symptom Questionnaire (DSQ) and Eckardt score. Manometric parameters of UES function (mean basal pressure, mean residual pressure, resting time and recovery time) as well as the other manometric parameters were analyzed and correlated through multifactor statistical analysis (MFA) with clinical and epidemiological data.
Results
Data from 94 patients (73F/21M, mean age 66 years) were analyzed. 40.4% presented dysphagia, 46,8% GERD related symptoms and 12.8% Non-Cardiac Chest Pain (NCCP) as main clinical presentation at the time of HRM examination. Mean basal pressure of the lower esophageal sphincter (LES) was 50.85 mmHg (R19.5-78.8), mean integrated relaxation pressure (IRP) was 19.15 mmHg (R 15.2-40.4), mean Distal Contractile Integral (DCI) 5.031 (mmHg -cm-s) (R 3.487-7.345), mean Distal Latency 6.4 (R 4-10.2), mean UES basal pressure 53.3 mmHg (R27.8-220), mean UES residual pressure 8.75 mmHg (R 0.2 -70.9), mean UES resting time 181 ms (R48-476), mean recovery time 465 (R46-880). 34 patients (36.2%) had abnormal UES manometric parameters. Multifactorial statistical analysis revealed a statistically significant correlation of the pathological UES residual pressure with abnormal LES basal pressure (p = 0.040), dysphagia as main clinical symptom (p=0.030), LES length (p=0.013) and dysphagia symptom severity evaluated by DSQ: p=0.017 and Eckardt: p=0.041.
Conclusion
UES motility has not been extensively studied on HRM in patients affected by EGJOO. Our study revealed that a significant number of EGJOO patients presented abnormal UES function. UES motility abnormalities in these patients are correlated with abnormal LES function, symptoms severity and particularly characterize patients with predominant dysphagia.
References
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