{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:02:18Z","timestamp":1782777738068,"version":"3.54.5"},"reference-count":14,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T00:00:00Z","timestamp":1592870400000},"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":[[2020,12]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Timed barium swallow (TBS) is used to objectively measure response following achalasia therapy; however, findings can be discordant with symptoms. We hypothesized that measurement of surface area of the residual barium column would improve its utility in measuring outcome.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In a single\u2010center cohort, achalasia patients undergoing therapy between September 2015\u20102016 who had TBS were included. Four metrics of emptying were studied: Post\u2010therapy residual barium (a) absolute height and (b) surface area and percentage reduction in (c) residual height (%H) and (d) surface area (%SA) compared to pretherapy. Metrics were evaluated against symptom response (Eckardt score).<\/jats:p>\n <\/jats:sec>\n \n Key Results<\/jats:title>\n \n Twenty\u2010four achalasics (median age 43\u00a0year; 13 males) were included; 14 received pneumatic dilatation, and 10 had peroral endoscopic myotomy. Treatment resulted in significant reduction in median Eckardt score (7 to 1;\n P<\/jats:italic>\n \u00a0=\u00a0.03), mean residual barium column height (14.7\u00a0\u00b1\u00a08.7 to 7.9\u00a0\u00b1\u00a06.0\u00a0cm;\n P<\/jats:italic>\n \u00a0=\u00a0.01) and surface area (52.7\u00a0\u00b1\u00a043.5 to 24.5\u00a0\u00b1\u00a023.6\u00a0cm\n 2<\/jats:sup>\n ;\n P<\/jats:italic>\n \u00a0=\u00a0.02). There were 4 (17%) initial non\u2010responders (Eckardt\u00a0>\u00a03). % SA was best at discriminating between responders and non\u2010responders (area under curve 0.85\u00a0\u00b1\u00a00.08; sensitivity 100%, specificity 80%). Concordance with symptomatic response following therapy was 83% when using 45% as the cutoff for surface area reduction compared to pretherapy. Eight patients whose static barium height was discordant with symptoms became concordant when % SA was used as a measure of response.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions & Inferences<\/jats:title>\n Change in barium surface area is a superior measure of esophageal emptying and better correlates with treatment response than the conventional 5\u2010minute barium height in defining objective response to achalasia therapy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/nmo.13928","type":"journal-article","created":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T22:13:57Z","timestamp":1592950437000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["The timed barium swallow and its relationship to symptoms in achalasia: Analysis of surface area and emptying rate"],"prefix":"10.1111","volume":"32","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":"St. Vincent's Hospital Sydney Darlinghurst NSW Australia"},{"name":"St Vincent's Clinical School University of New South Wales Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Plumb","sequence":"additional","affiliation":[{"name":"GI Physiology Unit University College London Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Maynard","sequence":"additional","affiliation":[{"name":"GI Physiology Unit University College London Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert W.","family":"Leong","sequence":"additional","affiliation":[{"name":"Concord Repatriation General Hospital Concord NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3742-5163","authenticated-orcid":false,"given":"Rami","family":"Sweis","sequence":"additional","affiliation":[{"name":"GI Physiology Unit University College London Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.169.2.9242756"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2013.19.2.251"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.01209.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.318"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.50.6.765"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-310602"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1905380"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1010502"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-008-0730-5"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-2050.2005.00460.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13287"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.12.007"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-017-0568-7"}],"container-title":["Neurogastroenterology 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