{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T21:51:31Z","timestamp":1757454691756,"version":"3.41.2"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,1,7]],"date-time":"2020-01-07T00:00:00Z","timestamp":1578355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,16]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Although High resolution esophageal manometry (HRM) is the gold standard to assess esophageal motility, little is known about the stability of the manometric diagnosis over time and its implications for management. To assess the stability and usefulness of repeat HRM in patients presenting with esophageal symptoms over time we performed this retrospective study of patients with esophageal symptoms. Medical records, questionnaires, and HRM tracing were independently reviewed using the Chicago classification. The primary objective was to assess the stability of the manometric diagnosis over time; secondary objective was its change (positive or negative). At least one repeat study was performed in 86 patients (36% women, ages 20\u201386, with mild to moderate symptoms), while 26 had a third procedure. Mean intervals between studies were 15\u2009\u00b1\u20091.6\u00a0months (for baseline v. first study) and 13\u2009\u00b1\u20090.8\u00a0months (for second to third study). Of the 27 patients initially with a normal study, 11 changed (five had esophago-gastric junction outflow obstruction [EGJOO], two diffuse esophageal spasm [DES], one jackhammer esophagus [JE], and three ineffective esophageal motility [IEM] [41% change]). Of the 24 patients with initial EGJOO, only nine retained it (65.2% change). Of nine patients with initial DES, four changed (44.4% change). Similarly, different diagnosis was seen in 7 of 24 initial IEM patients (22.7% change). Only one patient had achalasia initially and this remained stable. Additional changes were noted on a third HRM. Fluidity in the HRM diagnosis over time questions its validity at any timepoint and raises doubts about the need for intervention.<\/jats:p>","DOI":"10.1093\/dote\/doz094","type":"journal-article","created":{"date-parts":[[2020,1,7]],"date-time":"2020-01-07T17:29:34Z","timestamp":1578418174000},"source":"Crossref","is-referenced-by-count":6,"title":["Changes in high-resolution manometric diagnosis over time: implications for clinical decision-making"],"prefix":"10.1093","volume":"33","author":[{"given":"George","family":"Triadafilopoulos","sequence":"first","affiliation":[{"name":"Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afrin","family":"Kamal","sequence":"first","affiliation":[{"name":"Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Zikos","sequence":"first","affiliation":[{"name":"Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Nguyen","sequence":"first","affiliation":[{"name":"Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John O","family":"Clarke","sequence":"first","affiliation":[{"name":"Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,1,7]]},"reference":[{"key":"2020031602573258600_ref1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/nyas.13709","article-title":"Indications and interpretation of esophageal function testing","volume":"1434","author":"Gyawali","year":"2018","journal-title":"Ann N Y Acad Sci."},{"key":"2020031602573258600_ref2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/nmo.12477","article-title":"The Chicago classification of esophageal motility disorders, v3.0","volume":"27","author":"Kahrilas","year":"2015","journal-title":"Neurogastroenterol Motil"},{"key":"2020031602573258600_ref3","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1016\/j.cgh.2018.04.026","article-title":"Advances in management of esophageal motility disorders","volume":"19","author":"Kahrilas","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2020031602573258600_ref4","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/j.1572-0241.2004.30124.x","article-title":"Complete elimination of reflux symptoms does not guarantee normalization of intra-esophageal and intra-gastric pH in patients with gastroesophageal reflux disease (GERD)","volume":"99","author":"Milkes","year":"2004","journal-title":"Am J Gastroenterol"},{"key":"2020031602573258600_ref5","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/j.1365-2036.2009.04142.x","article-title":"Development of the Gerd Q, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care","volume":"30","author":"Jones","year":"2009","journal-title":"Aliment Pharmacol 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Variation in esophageal physiology testing in clinical practice: Results from an international survey","volume":"30","author":"Sweis","year":"2018","journal-title":"Neurogastroenterol Motil"},{"issue":"4","key":"2020031602573258600_ref11","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/MCG.0000000000000402","article-title":"Characteristics of consecutive esophageal motility diagnoses after a decade of change","volume":"50","author":"Boland","year":"2016","journal-title":"J Clin Gastroenterol"},{"key":"2020031602573258600_ref12","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/j.1440-1746.2008.05561.x","article-title":"Age and gender affect likely manometric diagnosis: audit of a tertiary referral hospital clinical esophageal manometry service","volume":"24","author":"Andrews","year":"2009","journal-title":"J Gastroenterol Hepatol"},{"issue":"3","key":"2020031602573258600_ref13","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12953","article-title":"Do jackhammer contractions lead to achalasia? 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