Functional esophagogastric junction obstruction with intact peristalsis: A heterogeneous syndrome sometimes akin to achalasia

John R. Scherer, Monika A. Kwiatek, Nathanial J. Soper, John E. Pandolfino, Peter James Kahrilas

Research output: Contribution to journalArticlepeer-review

168 Scopus citations


Background: Some patients with suspected achalasia are found on manometry to have preserved peristalsis, thereby excluding that diagnosis. This study evaluated a series of such patients with functional esophagogastric junction (EGJ) obstruction. Methods: Among 1,000 consecutive high-resolution manometry studies, 16 patients had functional EGJ obstruction characterized by impaired EGJ relaxation and intact peristalsis. Eight patients with post-fundoplication dysphagia and similarly impaired EGJ relaxation were studied as a comparator group with mechanical obstruction. Intrabolus pressure (IBP) was measured 1 cm proximal to the EGJ. Sixty-eight normal controls were used to define normal IBP. Patients' clinical features were evaluated. Results: Functional EGJ obstruction patients presented with dysphagia (96%) and/or chest pain (42%). IBP was significantly elevated in idiopathic and post-fundoplication dysphagia patients versus controls. Among the idiopathic EGJ obstruction group treated with pneumatic dilation, BoToxTM, or Heller myotomy, only the three treated with Heller myotomy responded well. Among the post-fundoplication dysphagia patients, three of four responded well to redo operations. Conclusion: Functional EGJ obstruction is characterized by pressure topography metrics demonstrating EGJ outflow obstruction of magnitude comparable to that seen with post-fundoplication dysphagia. Affected patients experience dysphagia and/or chest pain. In some cases, functional EGJ obstruction may represent an incomplete achalasia syndrome.

Original languageEnglish (US)
Pages (from-to)2219-2225
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number12
StatePublished - Dec 2009
Externally publishedYes


  • Achalasia
  • Dysphagia
  • Esophagus
  • Manometry

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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