Korean J Gastroenterol.  2020 Oct;76(4):179-184. 10.4166/kjg.2020.76.4.179.

Diagnostic Approach for Esophagogastric Junction Outflow Obstruction

  • 1Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea


Esophageal manometry is the gold standard test for diagnosing primary esophageal motility disorder. With the various metrics of the high-resolution esophageal manometry, the Chicago classification provides a standard approach for the manometric diagnosis of esophageal motor disorders. In the Chicago classification, the esophagogastric junction dysfunction is an important major motor disorder, which includes achalasia subtypes and esophagogastric junction outflow obstruction. Esophagogastric junction outflow obstruction is defined manometrically as normal or weak esophageal peristalsis with incomplete relaxation of the lower esophageal sphincter. It is a heterogeneous disorder and usually has a benign clinical course. The small portion of an esophagogastric junction outflow obstruction is early or variant achalasia. In such cases, treatments directing the lower esophageal sphincter, such as balloon dilatation or per oral endoscopic myotomy, may be necessary. An adjunctive high-resolution manometry provocation test or other esophageal function tests, such as timed barium esophagogram, can help select those patients and predict the treatment outcomes.


Deglutative disorders; Esophagus; Obstruction


  • Fig. 1 Major esophageal motility disorder (according to the Chicago classification, ver. 3). (A) Achalasia type 1 (complete aperistalsis), type 2 (panesophageal pressurization), type 3 (spastic achalasia). (B) Esophgagogastric junction outflow obstruction. (C) Diffuse esophageal spasm. (D) Jackhammer esophagus. (E) Abscent contraction. Modified from Kahrilas et al.2.

  • Fig. 2 Manometric findings of esophagogastric junction outflow obstruction Incomplete relaxation of the esophagogastric junction (intergrated relaxation pressure ≥15 mmHg) with intact or weak esophageal peristalsis. Modified from Kahrilas et al.2.


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