{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:06:18Z","timestamp":1792587978391,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T00:00:00Z","timestamp":1614643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["DK092217"],"award-info":[{"award-number":["DK092217"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["DK109376"],"award-info":[{"award-number":["DK109376"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Esophagogastric junction (EGJ) barrier function is of fundamental importance in the pathophysiology of gastroesophageal reflux disease. Impaired EGJ barrier function leads to excessive distal esophageal acid exposure or, in severe cases, esophagitis. Hence, proposed high\u2010resolution manometry (HRM) metrics assessing EGJ integrity are clinically important and were a focus of the Chicago Classification (CC) working group for inclusion in CC v4.0. However, the EGJ is a complex sphincter comprised of both crural diaphragm (CD) and lower esophageal sphincter (LES) component, each of which is subject to independent physiological control mechanisms and pathophysiology. No single metric can capture all attributes of EGJ barrier function. The working group considered several potential metrics of EGJ integrity including LES\u2010CD separation, the EGJ contractile integral (EGJ\u2010CI), the respiratory inversion point (RIP), and intragastric pressure. Strong recommendations were made regarding LES\u2010CD separation as indicative of hiatus hernia, although the numerical threshold for defining hiatal hernia was not agreed upon. There was no agreement on the significance of the RIP, only that it could localize either above the LES or between the LES and CD in cases of hiatus hernia. There was agreement on how to measure the EGJ\u2010CI and that it should be referenced to gastric pressure in units of mmHg\u00a0cm, but the numerical threshold indicative of a hypotensive EGJ varied widely among reports and was not agreed upon. Intragastric pressure was endorsed as an important metric worthy of further study but there was no agreement on a numerical threshold indicative of abdominal obesity.<\/jats:p>","DOI":"10.1111\/nmo.14113","type":"journal-article","created":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T07:55:44Z","timestamp":1614758144000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Chicago Classification update (v4.0): Technical review of high\u2010resolution manometry metrics for EGJ barrier function"],"prefix":"10.1111","volume":"33","author":[{"given":"Peter J.","family":"Kahrilas","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Department of Medicine Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0181-9697","authenticated-orcid":false,"given":"Ravinder K.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5766-9598","authenticated-orcid":false,"given":"Serhat","family":"Bor","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Ege University School of Medicine Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey P.","family":"Kohn","sequence":"additional","affiliation":[{"name":"Department of Surgery Monash University Melbourne Victoria Australia"},{"name":"Melbourne Upper GI Surgical Group Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Lenglinger","sequence":"additional","affiliation":[{"name":"Clinic for Visceral Surgery and Medicine Inselspital Bern University Hospital and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumeet K.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Norton Thoracic Institute Dignity Health Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2120-6270","authenticated-orcid":false,"given":"Jordi","family":"Serra","sequence":"additional","affiliation":[{"name":"Digestive System Research Unit University Hospital Vall d\u2019Hebron Centro de Investigaci\u00f3n Biom\u00e9dica en Red de enfermedades hep\u00e1ticas y digestivas (CIBERehd Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Tatum","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Washington, and VA Puget Sound Health Care System Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7872-2033","authenticated-orcid":false,"given":"Rena","family":"Yadlapati","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01138.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.10.053"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2011.01733.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12168"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00130.2017"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12267"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12507"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640618769160"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.13720"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12606"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/dox048"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm18208"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2011.09.002"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13054"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13344"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12638"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12925"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12757"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm16008"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.12.016"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2008.01909.x"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-300633"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doy025"}],"container-title":["Neurogastroenterology &amp; Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.14113","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nmo.14113","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.14113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T21:29:02Z","timestamp":1693344542000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.14113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,2]]},"references-count":26,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1111\/nmo.14113"],"URL":"https:\/\/doi.org\/10.1111\/nmo.14113","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,2]]},"assertion":[{"value":"2020-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14113"}}