{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:02:59Z","timestamp":1785132179638,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Achalasia is a rare esophageal motility disorder in children. Peroral endoscopic myotomy (POEM) has emerged as a promising treatment yet standardized post\u2010treatment evaluation remains lacking. While high\u2010resolution manometry (HRM) is the diagnostic gold standard, its role post\u2010treatment is limited. Pressure\u2010flow analysis (PFA), derived from high\u2010resolution impedance manometry (HRIM), offers a novel approach to assessing bolus transport and esophageal emptying. We aimed to evaluate PFA metrics in pediatric achalasia patients before and after POEM and assess its utility in monitoring post\u2010treatment outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 13 pediatric patients (8 males; mean age 13.3\u2009\u00b1\u20093.38 years) with achalasia treated with POEM at a tertiary referral center between 2016 and 2024. Inclusion required both pre\u2010 and post\u2010POEM HRIM. HRM metrics were analyzed using Chicago Classification version 4.0 (CCv4.0), while PFA parameters, including impedance ratio (IR) and distension pressure during emptying (DPE), were calculated using the Swallow Gateway\u2122 platform.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All patients experienced symptomatic improvement, with the median Eckardt Symptom Score (ESS) significantly decreasing from 6 (range 2\u201310) to 0 (range 0\u20132;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002). Following POEM, there was a significant reduction in median integrated relaxation pressure (IRP4s: 35.6\u201315.8\u2009mmHg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002), although 7 out of 13 patients (53.8%) achieved IRP4s values below the upper limit of normal. Additionally, significant decreases were observed in median IR (0.65\u20130.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002) and median DPE (28.9\u201317.3\u2009mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0171). Subgroup analysis showed that improvements in IR and DPE occurred regardless of IRP4s normalization.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PFA enhances post\u2010POEM evaluation in pediatric achalasia, offering an objective assessment of esophageal emptying beyond conventional pressure metrics. This study supports the potential role of PFA in post\u2010treatment follow\u2010up, warranting further validation in larger cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70414","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T09:04:37Z","timestamp":1774256677000},"page":"159-166","source":"Crossref","is-referenced-by-count":0,"title":["Pressure\u2010flow analysis following peroral endoscopic myotomy in pediatric achalasia: Novel insights into esophageal emptying"],"prefix":"10.1002","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9333-6317","authenticated-orcid":false,"given":"Renato","family":"Tambucci","sequence":"first","affiliation":[{"name":"Gastroenterology and Nutrition Unit Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Chiarazzo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Nutrition Unit Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Rommel","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Experimental Otorhinolaryngology, Deglutology, Faculty of Medicine University of Leuven Leuven Belgium"},{"name":"Department of Gastroenterology (Neurogastroenterology &amp; Motility) University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Imondi","sequence":"additional","affiliation":[{"name":"Gastroenterology and Nutrition Unit Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Caldaro","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy and Surgery Unit, Gastroenterology and Nutrition Unit Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"De Angelis","sequence":"additional","affiliation":[{"name":"Gastroenterology and Nutrition Unit Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Balassone","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy and Surgery Unit, Gastroenterology and Nutrition Unit Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"OPBG CHENDO Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00356-8"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2015.10.057"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13239"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1244080"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2021.07.001"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12308"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002806"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001647"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(92)91428-7"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14120"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003000"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13113"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002080"},{"key":"e_1_2_8_19_1","unstructured":"OmariT. 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