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Distal oesophageal spasm — ESEGH MCQ

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HardLuminal GIDistal oesophageal spasmESEGH

A patient has dysphagia. Manometry shows elevated integrated relaxation pressure with preserved peristalsis but does not meet achalasia criteria. What is the next interpretation and step?

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Correct answer: A — Possible EGJ outflow obstruction; confirm with barium or FLIP

The best answer is “Possible EGJ outflow obstruction; confirm with barium or FLIP”. Elevated junctional relaxation pressure with preserved peristalsis is an inconclusive manometric pattern unless symptoms and supportive testing establish clinically relevant oesophagogastric-junction outflow obstruction; timed barium oesophagography or FLIP provides that confirmation. The alternatives “Definite type II achalasia; proceed without supportive testing”, “Distal oesophageal spasm; confirm normal junctional relaxation”, “Absent contractility; assess the associated reflux burden”, “Hypercontractile oesophagus; review relevant opioid exposure, after specialist review” are plausible in related gastroenterology presentations but do not match the defining finding, threshold, sequence or UK pathway in this stem.

Reference: BSG and ESGE endoscopy guideline: https://gut.bmj.com/content/70/9/1611