{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T03:20:43Z","timestamp":1785554443221,"version":"3.56.0"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The esophageal response to stepwise distension during the functional lumen imaging probe (FLIP) Panometry study often parallels high\u2010resolution manometry (HRM) motility diagnoses. This study aimed to describe the changes in FLIP metrics during FLIP emptying, that is, reduced volume distension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult patients who completed FLIP and HRM for esophageal motility evaluation were included. Esophagogastric junction (EGJ) opening parameters were assessed during stepwise FLIP filling to volumes of 60\u2009mL (\u201cfilling 60\u2009mL\u201d), then 70\u2009mL, and then back to 60\u2009mL (\u201cemptying 60\u2009mL\u201d). HRM studies were analyzed per Chicago classification version 4.0 (CCv4.0).<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Among 265 patients included, HRM\/CCv4.0 diagnoses included achalasia in 80 patients (30%), normal motility in 70 (26%), and ineffective esophageal motility (IEM) in 43 (16%). EGJ\u2010distensibility index (DI) and EGJ diameter were greater during emptying 60\u2009mL than filling 60\u2009mL in achalasia, normal motility, and IEM (<jats:italic>p<\/jats:italic> values &lt;0.002). If applying the emptying 60\u2009mL EGJ\u2010DI (vs. filling 60\u2009mL EGJ\u2010DI), EGJ opening classification changed from reduced EGJ opening to borderline EGJ opening in 31% of achalasia patients and in 2% of patients with normal motility or IEM. EGJ opening classification was unchanged in 69% achalasia and 96% of normal motility\/IEM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>This study suggests that isotonic or auxotonic relaxation of the lower esophageal sphincter occurs with reduced volume distension in patients with achalasia and normal motility. The study also supports the importance of utilizing a standardized FLIP motility study protocol (i.e., controlled, stepwise filling to 50\u2009mL, 60\u2009mL, then 70\u2009mL) to provide reliable and generalizable FLIP metrics to facilitate diagnosis of esophageal motility disorders.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14663","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T07:50:11Z","timestamp":1694418611000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Relaxation of the lower esophageal sphincter in response to reduced volume distension during <scp>FLIP<\/scp> Panometry"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4015-7178","authenticated-orcid":false,"given":"Jeanine","family":"Wakim\u00a0El\u2010Khoury","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University  Chicago Illinois USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Centre Hospitalier Universitaire Vaudois (CHUV)  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bidemi","family":"Godo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine 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