{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T12:36:43Z","timestamp":1781354203065,"version":"3.54.1"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T00:00:00Z","timestamp":1507852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ineffective esophageal motility (<jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content>) is the most common finding on high\u2010resolution esophageal manometry (<jats:styled-content style=\"fixed-case\">HREM<\/jats:styled-content>). The underlying mechanisms for <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content> remain to be fully elucidated. The aim of this study was to determine if utilization of skeletal muscle relaxants is associated with <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content>, and with more severe subtypes of the disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with diagnosis of <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content> were gender and age matched to patients with normal <jats:styled-content style=\"fixed-case\">HREM<\/jats:styled-content>. Demographic information, symptoms, endoscopic findings, medication usage and medical comorbidities were recorded. Patients with a diagnosis of <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content> were divided into subgroups based on mean distal contractile integral (<jats:styled-content style=\"fixed-case\">DCI<\/jats:styled-content>) and percentage of ineffective swallows, and assessed for clinically significant differences among patients with varying severity of underlying <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>A total of 118 patients were included in each group. There were no significant clinical differences between the group of patients with <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content> and the group of patients with normal manometry. Within the group of <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content> patients, those with mean <jats:styled-content style=\"fixed-case\">DCI<\/jats:styled-content>\u00a0&lt;\u00a0250\u00a0mm\u00a0Hg\/s\/cm were more likely to be prescribed skeletal muscle relaxants (27.8% vs 11.0%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.044), and those using skeletal muscle relaxants had a larger mean percentage of ineffective swallows (81.1% vs 71.5%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.029). There were no significant differences across mean <jats:styled-content style=\"fixed-case\">DCI<\/jats:styled-content> subgroups in usage of any other medication, or in any of the demographic variables or disease comorbidities examined in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>Use of skeletal muscle relaxants is associated with more severe <jats:styled-content style=\"fixed-case\">IEM<\/jats:styled-content>, which may suggest a causal association between this class of medications and weaker esophageal peristalsis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13235","type":"journal-article","created":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T10:34:07Z","timestamp":1507890847000},"source":"Crossref","is-referenced-by-count":12,"title":["Severity of ineffective esophageal motility is associated with utilization of skeletal muscle relaxant medications"],"prefix":"10.1111","volume":"30","author":[{"given":"V.","family":"Rangan","sequence":"first","affiliation":[{"name":"The Esophageal and Swallowing Center Division of Gastroenterology and Hepatology MetroHealth Medical Center  Cleveland OH USA"},{"name":"Case Western Reserve University School of Medicine  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. S.","family":"George","sequence":"additional","affiliation":[{"name":"The Esophageal and Swallowing Center Division of Gastroenterology and Hepatology MetroHealth Medical Center  Cleveland OH USA"},{"name":"Case Western Reserve University School of Medicine  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Khan","sequence":"additional","affiliation":[{"name":"The Esophageal and Swallowing Center Division of Gastroenterology and Hepatology MetroHealth Medical Center  Cleveland OH USA"},{"name":"Case Western Reserve University School of Medicine  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Geng","sequence":"additional","affiliation":[{"name":"The Esophageal and Swallowing Center Division of Gastroenterology and Hepatology MetroHealth Medical Center  Cleveland OH USA"},{"name":"Case Western Reserve University School of Medicine  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Gabbard","sequence":"additional","affiliation":[{"name":"The Esophageal Center The Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Kichler","sequence":"additional","affiliation":[{"name":"The Esophageal Center The Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Gittleman","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4807-3052","authenticated-orcid":false,"given":"R.","family":"Fass","sequence":"additional","affiliation":[{"name":"The Esophageal and Swallowing Center Division of Gastroenterology and Hepatology MetroHealth Medical Center  Cleveland OH USA"},{"name":"Case Western Reserve 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