{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:32:33Z","timestamp":1792510353528,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Backgrounds<\/jats:title>\n                    <jats:p>Esophageal motility abnormalities may contribute to symptoms in eosinophilic esophagitis (EoE), but most available evidence is based on Chicago Classification version 3.0 (CCv3.0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We evaluated the prevalence and clinical relevance of motility disorders defined according to CCv4.0 in patients with EoE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively included consecutive untreated patients with EoE who underwent upper endoscopy and high\u2010resolution manometry at four Italian tertiary centers between 2016 and 2024. Manometric tracings were reanalyzed according to both CCv3.0 and CCv4.0. Associations between ineffective esophageal motility (IEM), symptoms, diagnostic delay, and Endoscopic Reference System (EREFS) findings were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      106 patients were included in the analysis. CCv4.0 identified IEM in 15 patients (14.2%), compared with 29 (27.4%) using CCv3.0, while normal motility increased from 60.4% to 75.5%. Food impaction occurred in 14\/15 patients with CCv4.0\u2010defined IEM. CCv4.0\u2010defined IEM was independently associated with food impaction (OR 6.92, 95% CI 1.37\u201334.94;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019), whereas CCv3.0\u2010defined IEM was not. According to CCv4.0, IEM was strongly associated with both inflammatory (93.3% vs. 57.5%; OR 10.35, 95% CI 1.30\u201382.55;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008) and fibrostenotic endoscopic phenotypes (73.3% vs. 35.0%; OR 5.11, 95% CI 1.49\u201317.53;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009), whereas no significant associations were observed using CCv3.0.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CCv4.0 reduces the prevalence of IEM and identifies a more clinically and endoscopically relevant hypomotility phenotype in EoE, characterized by a strong association with food impaction and both inflammatory and fibrostenotic endoscopic features. These findings support the clinical relevance of the more stringent CCv4.0 criteria for functional phenotyping in EoE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70442","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:46:31Z","timestamp":1789713991000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ineffective Esophageal Motility Defined by Chicago Classification v4.0 Identifies a Clinically and Endoscopically Relevant Phenotype in Eosinophilic Esophagitis"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5102-1758","authenticated-orcid":false,"given":"Mentore","family":"Ribolsi","sequence":"first","affiliation":[{"name":"Department of Digestive Diseases Campus Bio Medico University of Rome  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-8605","authenticated-orcid":false,"given":"Elisa","family":"Marabotto","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine University of Genoa  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1995-1060","authenticated-orcid":false,"given":"Nicola","family":"De Bortoli","sequence":"additional","affiliation":[{"name":"Department of New Technologies and Translational Research in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-5301","authenticated-orcid":false,"given":"Pierfrancesco","family":"Visaggi","sequence":"additional","affiliation":[{"name":"Department of New Technologies and Translational Research in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"De Carlo","sequence":"additional","affiliation":[{"name":"Department of Digestive Diseases Campus Bio Medico University of Rome  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5370-2642","authenticated-orcid":false,"given":"Michele","family":"Cicala","sequence":"additional","affiliation":[{"name":"Department of Digestive Diseases Campus Bio Medico University of Rome  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-2894","authenticated-orcid":false,"given":"Edoardo Vincenzo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology University of Padua School of Medicine and Surgery  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.009"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640616689525"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2024.02.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.71"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101746.2011.06770.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/17474124.2022.2047648"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.07.056"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2022.01.003"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14467"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2021.05.017"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iac.2023.12.007"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2016.06.021"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.06.034"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14134"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002491"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ueg2.70062"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00290.2020"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.14196"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-022-07419-6"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.11.002"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2023.05.031"},{"issue":"3","key":"e_1_2_10_25_1","first-page":"1","article-title":"Newly 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