{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T12:47:14Z","timestamp":1785242834746,"version":"3.55.0"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T00:00:00Z","timestamp":1705276800000},"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":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies have demonstrated that 50% of patients with normal high\u2010resolution manometry (HRM) findings or ineffective esophageal motility (IEM) may have abnormal functional luminal imaging probe (FLIP) results. However, the specific HRM findings associated with abnormal FLIP results are unknown. Herein, we investigated the relationship between nonspecific manometry findings and abnormal FLIP results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed 684 patients who underwent HRM at a tertiary care center in Seoul, Korea, based on the Chicago Classification version 4.0 protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Among the 684 patients, 398 had normal HRM findings or IEM. Of these 398 patients, eight showed esophageal wall thickening on endoscopic ultrasonography or computed tomography; however, no abnormalities were seen during esophagogastroduodenoscopy. Among these eight patients, seven showed repetitive simultaneous contractions (RSCs) in at least one of the two positions: 61% (\u00b129%) in 10 swallows in the supine position and 51% (\u00b130%) in five swallows in the upright position. Four patients who underwent FLIP had a significantly decreased esophagogastric junction distensibility index (1.0\u2009\u00b1\u20090.5  at 60\u2009mL). Two of these patients underwent per\u2010oral endoscopic myotomy (POEM) due to a lack of response to medication. Esophageal muscle biopsy revealed hypertrophic muscle with marginal eosinophil infiltration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>A subset of patients (2%) with normal HRM findings or IEM and RSCs experienced dysphagia associated with poor distensibility of the thickened esophageal wall. FLIP assessment or combined HRM and impedance protocols may help better define these patients who may respond well to POEM.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14736","type":"journal-article","created":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T06:25:28Z","timestamp":1705386328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Dysphagia associated with esophageal wall thickening in patients with nonspecific high\u2010resolution manometry findings: Understanding motility beyond the Chicago classification version 4.0"],"prefix":"10.1111","volume":"36","author":[{"given":"Jin Young","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Kyungpook National University Hospital  Daegu South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3771-3691","authenticated-orcid":false,"given":"Kee Wook","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Department of Medicine, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungmin","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pathology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Kyong","family":"Na","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Yong","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee Don","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho June","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gin Hyug","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwoon\u2010yong","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Asan Medical Center University of Ulsan College of Medicine  Seoul South 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