{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:26:02Z","timestamp":1792697162019,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aims<\/jats:title>\n Nonobstructive dysphagia (NOD) is a frequently encountered condition. The spectrum of underlying esophageal motility disorders remains incompletely characterized in Asian populations. We aimed to define the manometric spectrum of NOD, identify predictors of achalasia, and evaluate the diagnostic value of provocative testing.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective multicenter study included adults who underwent high\u2010resolution manometry (HRM) for NOD at two tertiary hospitals in Malaysia from 2014 to 2023. Diagnoses were classified according to Chicago Classification v3.0. Clinical predictors of achalasia were evaluated. The discriminatory performance of rapid drink challenge (RDC)\u2013integrated relaxation pressure (IRP) in differentiating achalasia from non\u2010achalasia was explored.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 230 patients (mean age 53.3; 47.0% male), achalasia was identified in 23.9%, esophagogastric junction outflow obstruction (EGJOO) in 17.3%, and ineffective esophageal motility in 24.8%. Weight loss (adjusted OR 2.99, 95% CI 1.25\u20137.15,\n p<\/jats:italic>\n \u2009=\u20090.014), absence of dyspepsia (adjusted OR 0.09, 95% CI 0.02\u20130.45,\n p<\/jats:italic>\n \u2009=\u20090.004), and presence of nausea\/vomiting (adjusted OR 3.35, 95% CI 1.34\u20138.40,\n p<\/jats:italic>\n \u2009=\u20090.010) independently predicted achalasia. RDC\u2010IRP demonstrated strong discrimination between achalasia and non\u2010achalasia (AUC 0.894, 95% CI 0.794\u20130.993,\n p<\/jats:italic>\n \u2009<\u20090.001), with an optimal threshold of approximately 18\u2009mmHg (sensitivity 90%, specificity 76.9%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Achalasia constitutes a substantial proportion of patients evaluated for NOD in tertiary care settings. Specific clinical features may aid early recognition. RDC may provide incremental diagnostic value and may serve as a practical adjunctive tool in differentiating achalasia from EGJOO.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgh.70713","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:04:40Z","timestamp":1788912280000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Spectrum of Esophageal Motility Disorders in Nonobstructive Dysphagia: A Multicenter, Multiethnic Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3053-4449","authenticated-orcid":false,"given":"Jun Xin","family":"Lim","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram","family":"Prasad","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6693-0456","authenticated-orcid":false,"given":"Nabilah","family":"Izham","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Faculty of Medicine Universiti Teknologi MARA Shah Alam Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wah Loong","family":"Chan","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Ramasami","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine Hospital Pulau Pinang Penang Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4755-859X","authenticated-orcid":false,"given":"Wei Jin","family":"Wong","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Department of Surgery, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5824-0590","authenticated-orcid":false,"given":"Sanjiv","family":"Mahadeva","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeong Yeh","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Medical Sciences Universiti Sains Malaysia Kota Bharu Malaysia"},{"name":"Division of Gastroentero\u2010Hepatology, Department of Internal Medicine, Faculty of Medicine\u2014Dr. Soetomo Teaching Hospital Universitas Airlangga Surabaya Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9811-7546","authenticated-orcid":false,"given":"Kee Huat","family":"Chuah","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"issue":"8","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1002\/ueg2.70088","article-title":"Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility","volume":"13","author":"Mari A.","year":"2025","journal-title":"United European Gastroenterology Journal"},{"issue":"11","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1016\/j.jfma.2018.12.019","article-title":"Etiologies and Clinical Characteristics of Non\u2010Obstructive Dysphagia in a Taiwanese Population: A Prospective study Based on High\u2010Resolution Impedance Manometry","volume":"118","author":"Yeh C.\u2010C.","year":"2019","journal-title":"Journal of the Formosan Medical Association"},{"issue":"4","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.gtc.2011.09.006","article-title":"Challenges in the Swallowing Mechanism: Nonobstructive Dysphagia in the Era of High\u2010Resolution Manometry and Impedance","volume":"40","author":"Roman S.","year":"2011","journal-title":"Gastroenterology Clinics of North America"},{"issue":"1","key":"e_1_2_8_5_1","doi-asserted-by":"crossref","DOI":"10.1002\/jgh3.70093","article-title":"Editorial: The Role of Esophageal Manometry in Diagnosing Achalasia and Esophageal Motility Disorders: Challenges and Advances","volume":"9","author":"Chuah K. 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