Factors Associated With Esophagogastric Junction Outflow Obstruction and Spastic Esophageal Motility Disorders: 362

INTRODUCTION: Advances in high resolution manometry (HRM) have resulted in increasing identification of major esophageal motility disorders in addition to achalasia type I and II. These include esophagogatric junction outflow obstruction (EGJOO) and spastic esophageal disorders (SEDs) which include distal esophageal spasm, jackhammer esophagus, and type III achalasia. The aim of this study was to identify the prevalence of and factors associated with EGJOO and SEDs among patients referred for high resolution esophageal manometry. METHODS: This is a retrospective study of adult patients who underwent high resolution manometry at a single tertiary-care center between 1/1/14-11/1/18. The following data were collected through electronic health records: demographics, medical and surgical history, medications, endoscopic findings and manometry results. Patients diagnosed with normal esophageal motility, EGJOO or a SED according to Chicago Classification v3.0, without prior history of foregut surgery were included. RESULTS: Overall, 911 studies were performed during the study period: 293 (32%) normal motor function, 88 (10%) EGJOO and 44 (5%) SEDs (17 type III achalasia, 19 jackhammer esophagus, 8 distal esophageal spasm). Thus, 425 patients were included in the final analysis [95 (32%) male, mean age 55.8 years, mean body mass index 27.5 kg/m 2 ]. Patients with SEDs or EGJOO were more likely to have comorbid hypertension (55% or 46% vs 32%; P = 0.02 or P = 0.05, respectively) when compared to patients with normal motility. Further, patients with EGJOO and SEDs were older (62.8 or 58.8 vs 53.7 years; P < 0.01 for both) and those with SEDs were more likely to use opiates (43% vs 20%; P = 0.01). Patients with SEDs and EGJOO were also more likely to have comorbid connective tissue disease (17.2% or 14.0% vs 9.7%; P = 0.09 for both) (Table 1). CONCLUSION: Among 911 patients who underwent high resolution manometry studies, 10% had EGJOO and 5% had SEDs. Those with EGJOO and SEDs were likely to be older and had comorbid hypertension. Further, connective tissue disorder was more common with EGJOO and SED. These results suggest that the underlying physiologic of spastic and obstructive esophageal motility disorders may be related to microvascular or connective tissue pathology.