{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T09:00:15Z","timestamp":1792314015335,"version":"4.4.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:00:00Z","timestamp":1638403200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["KL2TR001879"],"award-info":[{"award-number":["KL2TR001879"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson\u2019s chi-square tests were used to assess for associations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6\u00a0month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P\u2009=\u20090.03 and P\u2009=\u20090.03.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/dote\/doab077","type":"journal-article","created":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T06:27:18Z","timestamp":1638685638000},"source":"Crossref","is-referenced-by-count":13,"title":["Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?"],"prefix":"10.1093","volume":"35","author":[{"given":"Claire A","family":"Beveridge","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R","family":"Triggs","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1835-1381","authenticated-orcid":false,"given":"Shivani U","family":"Thanawala","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin K","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary W","family":"Falk","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain J","family":"Benitez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristle L","family":"Lynch","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,2]]},"reference":[{"key":"2022041911313591700_ref1","doi-asserted-by":"crossref","DOI":"10.1016\/j.cgh.2019.07.044","article-title":"Low yield of cross-sectional imaging in patients with esophagogastric junction outflow obstruction","volume":"18","author":"Beveridge","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"6","key":"2022041911313591700_ref2","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.cgh.2015.12.041","article-title":"Functional and anatomic esophagogastic junction outflow obstruction: manometry, timed barium esophagram findings, and treatment outcomes","volume":"14","author":"Clayton","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"8","key":"2022041911313591700_ref3","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1111\/nmo.12814","article-title":"Anatomic abnormalities are common potential explanations of manometric esophagogastric junction outflow obstruction","volume":"28","author":"DeLay","year":"2016","journal-title":"Neurogastroenterol Motil"},{"issue":"6","key":"2022041911313591700_ref4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/dote\/dox004","article-title":"Clinical presentation and disease course of patients with esophagogastric junction outflow obstruction","volume":"30","author":"Lynch","year":"2017","journal-title":"Dis Esophagus"},{"issue":"6","key":"2022041911313591700_ref5","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13061","article-title":"What is the clinical significance of esophagogastric junction outflow obstruction? 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