{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:14:48Z","timestamp":1793646888371,"version":"4.5.1"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T00:00:00Z","timestamp":1660608000000},"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":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Type II achalasia (Ach2) is distinguished from other achalasia sub\u2010types by the presence of panesophageal pressurization (PEP) of \u226530\u2009mmHg in \u226520% swallows on high\u2010resolution manometry (HRM). Variable manometric features in Ach2 have been observed, characterized by focal elevated pressures (FEPs) (focal\/segmental pressures \u226570\u2009mmHg within the PEP band) and\/or high compression pressures (PEP \u226570\u2009mmHg). This study aimed to examine clinical and physiologic variables among sub\u2010groups of Ach2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective single center study performed over 3\u2009years (1\/2019\u20131\/2022) included adults with Ach2 on HRM who underwent endoscopic ultrasound (EUS), functional lumen imaging probe (FLIP), and\/or barium esophagram (BE) prior to therapy. Patients were categorized into two overarching sub\u2010groups: Ach2 without FEPs and Ach2 with FEPs. Demographic, clinical, and physiologic data were compared between these sub\u2010groups utilizing unpaired univariate analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Of 53 patients with Ach2, 40 (75%) were without FEPs and 13 (25%) had FEPs. Compared with the Ach2 sub\u2010group without FEPs, the Ach2 sub\u2010group with FEPs demonstrated a significantly thickened distal esophageal circular muscle on EUS (1.4\u2009mm [SD 0.9] vs. 2.1 [0.7];<jats:italic>p<\/jats:italic>\u00a0=\u00a00.02), higher prevalence of tertiary contractions on BE (46% vs. 100%;<jats:italic>p<\/jats:italic>\u00a0=\u00a00.0006), lower esophagogastric junction distensibility index (2.2mm<jats:sup>2<\/jats:sup>\/mmHg [0.9] vs 0.9 [0.4];<jats:italic>p<\/jats:italic>\u00a0=\u00a00.0008) as well as higher distensive pressure (31.0\u2009mmHg [9.8] vs. 55.4 [18.8];<jats:italic>p<\/jats:italic>\u00a0=\u00a00.01) at 60\u2009cc fill on FLIP, and higher prevalence of chest pain on Eckardt score (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>We identified a distinct sub\u2010group of type II achalasia on HRM, defined as type II achalasia with focal elevated pressures. This sub\u2010group uniquely exhibits spastic features and may benefit from personalized treatment approaches.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14449","type":"journal-article","created":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T13:09:05Z","timestamp":1660655345000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Type<scp>II<\/scp>achalasia with focal elevated pressures: A distinct manometric and clinical<scp>sub\u2010group<\/scp>"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0852-8005","authenticated-orcid":false,"given":"Eric E.","family":"Low","sequence":"first","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Abbas","family":"Fehmi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aws","family":"Hasan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Kwong","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary L.","family":"Krinsky","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gobind","family":"Anand","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Greytak","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Kaizer","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; 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