{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:37:51Z","timestamp":1790285871123,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,12,21]],"date-time":"2017-12-21T00:00:00Z","timestamp":1513814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Washington University Department of Medicine Mentors in Medicine (MIM)"},{"name":"Clinical Science Training and Research (CSTAR)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Distal contractile integral (DCI) and esophagogastric junction contractile integral (EGJ\u2010CI) are high\u2010resolution manometry (HRM) software metrics assessing esophageal motor function in gastroesophageal reflux disease (GERD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing HRM and ambulatory pH monitoring off antisecretory therapy prospectively completed symptom questionnaires assessing symptom burden and a global symptom score (GSS) at baseline and after GERD therapy. DCI&lt;450\u00a0mm\u00a0Hg\/cm\/s in \u22655 swallows diagnosed ineffective esophageal motility (IEM); proportions of failed (DCI&lt;100\u00a0mm\u00a0Hg\/cm\/s) and weak (DCI 100\u2010450\u00a0mm\u00a0Hg\/cm\/s) sequences were separately assessed. EGJ\u2010CI assessed vigor of the EGJ barrier. Univariate and multivariate analyses addressed performance of esophageal body and EGJ metrics in predicting abnormal esophageal reflux burden, and symptom outcome from antireflux therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Of 188 patients (55.2\u00a0\u00b1\u00a00.9\u00a0year, 64% F), 42.6% had low EGJ\u2010CI, and 25.0% had IEM. While low EGJ\u2010CI was associated with abnormal reflux burden (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.003), IEM alone was not (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.2). Increasing proportions of failed swallows predicted abnormal AET better than the current IEM definition. Combined low EGJ\u2010CI and IEM segregated abnormal total and supine acid burden compared to patients with normal EGJ\u2010CI and no IEM (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.007 for each comparison). Medical therapy and surgical antireflux therapy were similarly effective in improving symptom burden; surgery resulted in better outcomes with low EGJ\u2010CI (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.04), especially with intact esophageal body motor function (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>While abnormal EGJ and esophageal body metrics are collectively associated with elevated esophageal reflux burden, increasing proportions of failed swallows are better predictors of reflux burden and outcome compared to the current IEM definition.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13267","type":"journal-article","created":{"date-parts":[[2017,12,21]],"date-time":"2017-12-21T15:47:45Z","timestamp":1513871265000},"source":"Crossref","is-referenced-by-count":83,"title":["Esophagogastric junction and esophageal body contraction metrics on high\u2010resolution manometry predict esophageal acid burden"],"prefix":"10.1111","volume":"30","author":[{"given":"A.","family":"Rengarajan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  Saint Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Bolkhir","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  Saint Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Gor","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  Saint Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  Saint Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Munigala","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  Saint Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. 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