{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:35:30Z","timestamp":1792510530088,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,4,7]],"date-time":"2019-04-07T00:00:00Z","timestamp":1554595200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Achalasia diagnosis requires elevated integrated relaxation pressure (IRP; manometric marker of lower esophageal sphincter [LES] relaxation). Yet, some patients exhibit clinical features of achalasia despite normal IRP and have LES dysfunction demonstrable by other means. We hypothesized these patients to exhibit equivalent therapeutic response compared to standard achalasia patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Symptomatic achalasia\u2010like cases, despite normal IRP, displayed evidence of impaired LES relaxation using rapid drink challenge (RDC), solid swallows during high\u2010resolution manometry, and\/or barium esophagogram; were treated with achalasia therapies and compared to standard achalasia patients with raised IRP. Outcomes included equivalence for short\u2010 and long\u2010term symptom response and stasis on barium esophagogram.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Twenty\u2010nine normal IRP achalasia cases (14 males, median age 50\u00a0year, median Eckardt 6, barium stasis 12\u00a0\u00b1\u00a07\u00a0cm) and 29 consecutive standard achalasia controls underwent therapy. Among cases, LES dysfunction was most often identified by RDC and\/or barium esophagogram. Short\u2010term symptomatic success was equivalent in cases vs controls (90% vs 93%; 95% CI for difference: \u221219% to 13%). Median short\u2010term (1 vs 1; 95% CI for difference: 0\u20101) and long\u2010term Eckardt scores (2 vs 1; 95% CI for difference: 0\u20102) were similar in cases and controls, respectively. Adequate clearance was observed in 67% of cases vs 81% of controls on post\u2010therapy esophagogram.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>We described a subset of achalasia patients with normal IRP, but impaired LES relaxation identifiable only on additional provocative tests. These patients benefited from treatment, suggesting that such tests should be performed to increase the number of clinically relevant diagnoses.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13586","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T00:34:19Z","timestamp":1554683659000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Achalasia diagnosed despite normal integrated relaxation pressure responds favorably to therapy"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3145-1050","authenticated-orcid":false,"given":"Santosh","family":"Sanagapalli","sequence":"first","affiliation":[{"name":"GI Physiology Unit University College London Hospital London UK"},{"name":"Department of Gastroenterology St. Vincent's Hospital Sydney Darlinghurst Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-7638","authenticated-orcid":false,"given":"Sabine","family":"Roman","sequence":"additional","affiliation":[{"name":"H\u00f4pital Edouard Herriot Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Hastier","sequence":"additional","affiliation":[{"name":"H\u00f4pital Edouard Herriot Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert W.","family":"Leong","sequence":"additional","affiliation":[{"name":"Gastroenterology &amp; 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