{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T15:26:53Z","timestamp":1790436413476,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,1,24]],"date-time":"2022-01-24T00:00:00Z","timestamp":1642982400000},"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":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Functional lumen imaging probe (FLIP) panometry can show spastic secondary contractile patterns of unclear significance in symptomatic patients who have no esophageal obstructive disorders, and no motility disorders on high\u2010resolution manometry (HRM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed non\u2010obstructed, symptomatic patients with HRM findings of no motility disorder or ineffective esophageal motility (IEM) for whom spastic secondary contractile patterns identified by FLIP panometry were used to guide treatment. Symptoms were scored using the Brief Esophageal Dysphagia Questionnaire (BEDQ).<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>We identified ten symptomatic patients treated at our medical center who met inclusion criteria (seven women; mean age 56\u00a0years; eight no motility disorder, two IEM). On FLIP panometry, seven had spastic secondary contractions at 60\u00a0ml, two at 40\u00a0ml, and one at both 40\u00a0ml and 60\u00a0ml balloon volumes. Eight patients (80%) had improvement in BEDQ scores with therapies that targeted the spastic secondary contractile patterns identified by FLIP (five botulinum toxin injection, two Esoflip dilation, and one Heller myotomy). Interestingly, review of HRM tracings revealed that all patients had a novel HRM finding of mid\u2010vertical pressurization in at least 20% swallows, with seven exhibiting this finding in &gt;50% of swallows.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This case series demonstrates that treatments targeting spastic secondary contractions identified by FLIP panometry can result in symptomatic improvement in patients with no obstructive disorder and no diagnostic motility disorder on HRM. In such patients, we have identified the novel HRM finding of mid\u2010vertical pressurization, which might be the manometric manifestation of spasm limited to the mid\u2010esophagus.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14321","type":"journal-article","created":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T06:00:48Z","timestamp":1643090448000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Spastic secondary contractile patterns identified by FLIP panometry in symptomatic patients with unremarkable high\u2010resolution manometry"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6351-117X","authenticated-orcid":false,"given":"Anh D.","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Medicine Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashton","family":"Ellison","sequence":"additional","affiliation":[{"name":"Department of Medicine Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7741-1973","authenticated-orcid":false,"given":"Chanakyaram A.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Medicine Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roseann","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Department of Medicine Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4451-5439","authenticated-orcid":false,"given":"Eitan","family":"Podgaetz","sequence":"additional","affiliation":[{"name":"Department of Surgery Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Surgery Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3484-2807","authenticated-orcid":false,"given":"Rhonda F.","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Medicine Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5635-5386","authenticated-orcid":false,"given":"Stuart J.","family":"Spechler","sequence":"additional","affiliation":[{"name":"Department of Medicine Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vani\u00a0J.A.","family":"Konda","sequence":"additional","affiliation":[{"name":"Department of Medicine Center for Esophageal Diseases Baylor University Medical Center and Center for Esophageal Research Baylor Scott &amp; White Research Institute Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12040"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12941"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13505"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12572"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12908"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14116"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.454"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"e14192","DOI":"10.1111\/nmo.14192","article-title":"Validation of secondary peristalsis classification using FLIP panometry in 741 subjects undergoing manometry","volume":"34","author":"Carlson DA","year":"2021","journal-title":"Neurogastroenterol Motil"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.11.037"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(89)91688-0"},{"issue":"3","key":"e_1_2_10_13_1","first-page":"431","article-title":"Impedance planimetry: an integrated approach for assessing sensory, active, and passive biomechanical properties of the human esophagus","volume":"90","author":"Rao SS","year":"1995","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-124-11-199606010-00002"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.1990.tb00487.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-200107000-00007"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(77)80297-7"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01888544"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.03.021"}],"container-title":["Neurogastroenterology &amp; 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