Disorders of EGJ Outflow

Isolated EGJ outflow obstruction or achalasia. Achalasia: simult. ↓ amp contractions & ↓ LES relaxation; barium swallow w/ dilated esophagus & distal “bird’s beak” narrowing; mostly idiopathic, although can be a/w Chagas; Rx: pneumatic dilation as effective as Heller myotomy (local expertise dependent) (Gut 2016;65:732); peroral endoscopic myotomy; CCB/nitrates/PDEi; botox if Ø surg cand.