{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T23:59:24Z","timestamp":1783123164423,"version":"3.54.6"},"reference-count":54,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>In patients with achalasia, we hypothesized that visceral hypersensitivity arising from concomitant disorders of gut\u2013brain interaction (DGBI) may influence clinical presentation and response to therapy. Thus, in patients with achalasia, we assessed the clinical manifestations and response to peroral endoscopic myotomy (POEM) as well as the association with concomitant DGBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 52 consecutive patients with achalasia who underwent POEM, we assessed gastrointestinal (esophageal and nonesophageal) and extraintestinal symptoms utilizing the Structured Assessment of Gastrointestinal Symptoms Instrument (SAGIS). In addition, the response to POEM was assessed with the Eckardt Score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with type\u2010III achalasia had a greater prevalence of psychological co\u2010morbidities than type\u2010I patients (77.78% vs. 21.43%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Pre\u2010POEM, patients with type\u2010III achalasia had significantly more severe IBS\u2010type symptoms of constipation and diarrhea when compared with type\u2010I (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). The POEM procedure reduced the mean Eckardt scores in patients with type\u2010I (9.00\u2009\u00b1\u20092.18 vs. 1.00\u2009\u00b1\u20091.038,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), type\u2010II (9.28\u2009\u00b1\u20092.234 vs. 1.59\u2009\u00b1\u20091.547,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), and type\u2010III (7.67\u2009\u00b1\u20091.871 vs. 2.78\u2009\u00b1\u20092.635,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Based on the improvement of the Eckhardt score, 87% (45\/52) responded to POEM. In type\u2010III patients (5\/9), inferior response was noted compared to type\u2010I (14\/14 patients,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and type\u2010II (26\/29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Total SAGIS score decreased post\u2010POEM in patients with type\u2010I (baseline 18.29\u2009\u00b1\u200910.80 vs. post\u2010POEM 8.643\u2009\u00b1\u200911.76,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), and type\u2010II (29.55\u2009\u00b1\u200918.53 vs. 12.69\u2009\u00b1\u200915.61,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), but not in type\u2010III (baseline 34.22\u2009\u00b1\u200919.31 vs. post\u2010POEM 23.22\u2009\u00b1\u200914.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.18).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that altered gut\u2013brain interactions play a role in the clinical manifestations of patients with achalasia, particularly in patients with type\u2010III, and affect the response to therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70223","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T06:19:36Z","timestamp":1765865976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Disorders of Gut\u2013Brain Interaction (\n                    <scp>DGBI<\/scp>\n                    ) Symptoms and Response to Peroral Endoscopic Myotomy in Patients With Achalasia"],"prefix":"10.1111","volume":"38","author":[{"given":"Ronen Ben","family":"Jacob","sequence":"first","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Australia"},{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fairlie","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Australia"},{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2537-3092","authenticated-orcid":false,"given":"Nicholas J.","family":"Talley","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute and University of Newcastle  Newcastle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Australia"},{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Frankel","sequence":"additional","affiliation":[{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"},{"name":"Department of Upper Gastrointestinal Surgery Princess Alexandra Hospital  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Mark","family":"Smithers","sequence":"additional","affiliation":[{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"},{"name":"Department of Upper Gastrointestinal Surgery Princess Alexandra Hospital  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-4938","authenticated-orcid":false,"given":"Michael P.","family":"Jones","sequence":"additional","affiliation":[{"name":"Macquarie University, Department of Psychology  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke F.","family":"Hourigan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Australia"},{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Australia"},{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0206-2358","authenticated-orcid":false,"given":"Gerald","family":"Holtmann","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Australia"},{"name":"University of Queensland, Faculty of Health, Medicine and Behavioural Sciences  Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000731"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640620903213"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/729217"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12711"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng.3029"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm16177"},{"key":"e_1_2_10_8_1","article-title":"Incidence and Costs of Achalasia in The Netherlands","volume":"30","author":"Hoeij F. 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