{"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":1792587978357,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"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":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Esophagogastric junction contractile integral (EGJ\u2010CI) has not come into routine use due to methodological discrepancies and its unclear clinical utility. We aimed to determine which method of calculating EGJ\u2010CI was best at discriminating between common reflux disease states.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>High\u2010resolution manometry (HRM) and pH\u2010Impedance measurements were acquired for 100 patients; 25 Barrett's esophagus (&gt;3\u2009cm\/acid exposure time (AET)\u2009&gt;\u20096), 25 endoscopy\u2010negative reflux disease (ENRD; AET\u2009&gt;6), 25 borderline reflux (AET 4\u20136), 25 functional heartburn (FH; AET\u2009&lt;4), constituting the developmental cohort. EGJ\u2010CI was calculated at 20\u2009mmHg, 2\u2009mmHg, and 0\u2009mmHg isobaric contour. Empirical associations, univariable, multivariable and ROC analyses were performed between EGJ\u2010CI and manometric\/pH\u2010impedance metrics. A validation cohort (<jats:italic>n<\/jats:italic>\u2009=\u200925) was used to test the new EGJ\u2010CI cutoff.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Significant correlations with AET were observed when EGJ\u2010CI was calculated with an isobaric threshold of 20\u2009mmHg (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Significant differences in EGJ\u2010CI were observed between patients with FH and Barrett's esophagus (<jats:italic>p<\/jats:italic>\u2009=\u20090.004) and with ENRD (<jats:italic>p<\/jats:italic>\u2009=\u20090.01); however, LES basal pressure was unable to differentiate between these disease states (<jats:italic>p<\/jats:italic>\u2009=\u20090.09, <jats:italic>p<\/jats:italic>\u2009=\u20090.25, respectively). ROC analysis on the developmental cohort found that EGJ\u2010CI 21.2\u2009mmHg.cm demonstrated sensitivity 72% and specificity 72% between patients with reflux (Barrett's esophagus\/ENRD) and FH. In the validation cohort, 92.8% with a low EGJ\u2010CI had good\/moderate improvement in symptoms following therapy compared to 54.5% with raised EGJ\u2010CI (<jats:italic>p<\/jats:italic>\u2009=\u20090.026).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>This study re\u2010affirms EGJ\u2010CI as a reliable discriminator between reflux disease (Barrett's esophagus\/ENRD) and FH. In borderline reflux patients, patients with a lower EGJ\u2010CI score (&lt;21.2\u2009mmHg) appear to respond better to anti\u2010reflux therapies compared to those with a higher value.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14597","type":"journal-article","created":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T18:14:42Z","timestamp":1682360082000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Esophagogastric junction contractile integral (<scp>EGJ\u2010CI<\/scp>) complements reflux disease severity and provides insight into the pathophysiology of reflux disease"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0356-9919","authenticated-orcid":false,"given":"Humayra","family":"Dervin","sequence":"first","affiliation":[{"name":"GI Physiology Unit University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bassett","sequence":"additional","affiliation":[{"name":"Statsconsultancy Ltd  Amersham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Sweis","sequence":"additional","affiliation":[{"name":"GI Physiology Unit University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.4.476"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.10.053"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640618769160"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2982.2003.00446.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2011.01834.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/dote.12389"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.4199\/c00027ed1v01y201103isp016"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00444.2005"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12267"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12925"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12638"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm16008"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.13038"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.13720"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001205"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12757"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2011.09.002"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14009"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/dote.12163"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2008.01909.x"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2010.16.3.327"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.09.002"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.03178.x"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13752"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v6.i8.176"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13330"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2003.01423.x"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04742.x"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2011.01669.x"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-199705000-00019"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12301"}],"container-title":["Neurogastroenterology &amp; 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