{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:53:18Z","timestamp":1788850398156,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001786","name":"University of Adelaide","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001786","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Dysphagia and reflux are frequently experienced by individuals with hiatus hernia (HH), but the underlying mechanisms are not fully defined in radiological or manometric studies. This study explores the impact of HH on propulsive esophageal peristalsis and investigates the biomechanical underpinnings of HH\u2010concurrent\u2013related dysphagia in affected individuals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>High\u2010resolution manometry with impedance (HRM\u2010I) studies compared the biomechanics of 195 gastroesophageal reflux disease (GERD) patients (excluding large HH and motility disorders) and 20 normal healthy volunteers. Assessments included dysphagia severity, esophageal pH monitoring, and HRM\u2010I with 5\u2010mL liquid and viscous swallows. Bolus distension pressures during bolus transport and esophageal emptying parameters were assessed in conjunction with standard pressure topography metrics. Data grouped by EGJ morphology type were analyzed by a mixed\u2010effects statistical model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Patients with unequivocal HH exhibited altered bolus transport through the mid\u2010distal esophageal body, indicated by increased intrabolus distension pressure during bolus transport (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01 for liquid and viscous swallows) and shorter bolus flow time through the EGJ (<jats:italic>p<\/jats:italic>\u2009\u2264\u20090.005 for liquid and viscous swallows). Increased HH size during swallows also correlated with increased intrabolus distension pressure (liquid r 0.243, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and shorter EGJ flow time (liquid <jats:italic>r<\/jats:italic>\u2009\u2212\u20090.191, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.005). Patients with confirmed GERD without HH showed a different pattern of altered bolus transport in the more proximal esophagus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the presence of a HH, esophageal biomechanics are altered, with elevated bolus distension pressure revealing resistance to bolus transport occurring in the mid\u2010lower esophageal body for liquid and viscous boluses, contributing to dysphagia symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.70086","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T07:19:09Z","timestamp":1747725549000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Hiatus Hernia and Reflux on Bolus Transport Through the Esophagus and the Esophagogastric Junction and in Relation to Dysphagia"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2676-1353","authenticated-orcid":false,"given":"Ferm\u00edn","family":"Estremera\u2010Ar\u00e9valo","sequence":"first","affiliation":[{"name":"Discipline of Surgery University of Adelaide  Adelaide South Australia Australia"},{"name":"Gastroenterology Department Hospital Universitario de Navarra  Pamplona Spain"},{"name":"Navarrabiomed, IdisNa  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5108-7378","authenticated-orcid":false,"given":"Taher I","family":"Omari","sequence":"additional","affiliation":[{"name":"College of Medicine &amp; Public Health Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Dent","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2157-7098","authenticated-orcid":false,"given":"Jennifer C.","family":"Myers","sequence":"additional","affiliation":[{"name":"Discipline of Surgery University of Adelaide  Adelaide South Australia Australia"},{"name":"Oesophageal Function, Surgery, Royal Adelaide Hospital and Queen Elizabeth Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894\u2010017\u20100580\u2010y"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1018861715957"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2009.05.011"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165\u20101838(84)90017\u20101"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.81.11.3595"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cne.902830207"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00124.2022"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365529409092496"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/cgh.2003.50026"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12312"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12040"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102982.2012.01938.x"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836\u2010199203000\u201000004"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102017\u2010314722"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12246"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12267"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640618764936"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12369"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00119.2014"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2007.01138.x"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm23162"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-3565(04)00289-7"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199711000\u201000009"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010005\u20100022\u20100"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199004000\u201000005"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0b013e3283622b57"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14929"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1091\u2010255x(01)80046\u20109"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102982.2011.01831.x"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-85617-830-3.00005-5"}],"container-title":["Neurogastroenterology &amp; 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