{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:23:11Z","timestamp":1769008991487,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Panesophageal pressurization (PEP) defines type II achalasia on high\u2010resolution\u2010manometry (HRM) but some patients exhibit spasm after treatment. The Chicago Classification (CC) v4.0 proposed high PEP values as predictor of embedded spasm, yet supportive evidence is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty seven type II achalasia patients (47\u2009\u00b1\u200918\u2009years, 54% males) with HRM and LIP Panometry before and after treatment were retrospectively identified. Baseline HRM and FLIP studies were analyzed to identify factors associated with post\u2010treatment spasm, defined on HRM per CC v4.0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven patients (12%) had spasm following treatment (peroral endoscopic myotomy 47%; pneumatic dilation [PD] 37%; laparoscopic Heller myotomy 16%). At baseline, greater median maximum PEP pressure (MaxPEP) values on HRM (77 vs 55\u2009mmHg, <jats:italic>p<\/jats:italic>\u00a0=\u20090.045) and spastic\u2010reactive contractile response pattern on FLIP (43% vs 8%, <jats:italic>p<\/jats:italic>\u00a0=\u20090.033) were more common in patients with post\u2010treatment spasm while absent contractile response on FLIP was more common in patients without spasm (14% vs 66%, <jats:italic>p<\/jats:italic>\u00a0=\u20090.014). The strongest predictor of post\u2010treatment spasm was the percentage of swallows with MaxPEP \u226570\u2009mmHg (best cut\u2010off: \u226530%), with AUROC of 0.78. A combination of MaxPEP &lt;70\u2009mmHg and FLIP 60\u2009mL pressure\u2009&lt;\u200940\u2009mmHg identified patients with lower rates of post\u2010treatment spasm (3% overall, 0% post\u2010PD) compared to those with values above these thresholds (33% overall, 83% post\u2010PD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>High maximum PEP values, high FLIP 60\u2009mL pressures and contractile response pattern on FLIP Panometry prior to treatment identified type II achalasia patients more likely to exhibit post\u2010treatment spasm. Evaluating these features may guide personalized patient management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14552","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T17:19:18Z","timestamp":1676999958000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Identifying spastic variant of type <scp>II<\/scp> achalasia after treatment with high\u2010resolution manometry and <scp>FLIP<\/scp> Panometry"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5573-447X","authenticated-orcid":false,"given":"Edoardo","family":"Vespa","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Digestive Endoscopy IRCCS San Raffaele Hospital  Milan Italy"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico A.","family":"Farina","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8260-1250","authenticated-orcid":false,"given":"Peter J.","family":"Kahrilas","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2582-2070","authenticated-orcid":false,"given":"Wenjun","family":"Kou","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0852-8005","authenticated-orcid":false,"given":"Eric E.","family":"Low","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California, San Diego  California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7872-2033","authenticated-orcid":false,"given":"Rena","family":"Yadlapati","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of California, San Diego  California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-7758","authenticated-orcid":false,"given":"Dustin A.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00356-8"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000731"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2011.01834.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.07.022"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.12.027"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1010502"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.2996"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.03.058"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2013.19.2.126"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.04.033"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2013.19.3.407"},{"key":"e_1_2_11_15_1","first-page":"76","article-title":"Hypertensive panesophageal pressurization in type II achalasia","volume":"112","author":"Melcarne L","year":"2020","journal-title":"Rev Esp Enfermedades Dig Organo of la Soc Esp Patol Dig"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14182"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14449"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.15403\/jgld.2014.1121.281.ach"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12572"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.454"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001532"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.08.005"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13932"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(92)91428-7"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14192"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.06.040"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamasurg.38"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-5377-9"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm20126"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2020.07.041"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1905380"}],"container-title":["Neurogastroenterology &amp; Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.14552","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nmo.14552","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.14552","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T19:16:09Z","timestamp":1692472569000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.14552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":30,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1111\/nmo.14552"],"URL":"https:\/\/doi.org\/10.1111\/nmo.14552","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]},"assertion":[{"value":"2022-12-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14552"}}