{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:38:28Z","timestamp":1792471108463,"version":"4.5.0"},"reference-count":100,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Primary motor esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder identified by high\u2010resolution manometry (HRM) in the absence of an underlying structural or mechanical cause of obstruction. The clinical significance, management, and prognosis of primary motor EGJOO remain uncertain. This clinical practice update provides expert guidance on the evaluation and management of EGJOO, with particular emphasis on determining when the condition is \u201cactionable\u201d\u2014that is, likely to benefit from lower esophageal sphincter (LES)\u2010directed therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>With the endorsement of the European Society of Neurogastroenterology and Motility, an 11\u2010member international Working Group developed recommendation statements on EGJOO, focusing on the diagnosis and management of actionable primary motor EGJOO. Statements were developed based on available literature evidence and presented at virtual meetings. Each statement was voted upon by the Working Group, and statements reaching \u2265\u200980% agreement were included as recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve statements reached the agreement threshold. In summary, the Working Group agrees that actionable primary motor EGJOO should be defined by the coexistence of clinical symptoms, a characteristic HRM pattern, and non\u2010manometric corroborative tests, including endoscopy, barium esophagogram, and functional lumen imaging probe panometry, in the absence of secondary causes. Patients with actionable primary motor EGJOO may receive medical, endoscopic, and\/or surgical treatment, based on level of confidence in the diagnosis, while those without do not require LES\u2010directed invasive intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This clinical practice update represents an evidence and expert opinion\u2010based consensus on the most appropriate diagnostic and therapeutic workup of actionable primary motor EGJOO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70466","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:45:15Z","timestamp":1792467915000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis and Management of Actionable Primary Motor Esophagogastric Junction Outflow Obstruction: Clinical Practice Update of the European Society of Neurogastroenterology and Motility"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-5301","authenticated-orcid":false,"given":"Pierfrancesco","family":"Visaggi","sequence":"first","affiliation":[{"name":"Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"},{"name":"Digestive Endoscopy Unit, Department of General Surgery Pisa University Hospital  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. Prakash","family":"Gyawali","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1709-8230","authenticated-orcid":false,"given":"Walter W.","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-7758","authenticated-orcid":false,"given":"Dustin A.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"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":"Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0464-2217","authenticated-orcid":false,"given":"Adriana","family":"Lazarescu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-7638","authenticated-orcid":false,"given":"Sabine","family":"Roman","sequence":"additional","affiliation":[{"name":"Digestive Physiology, Hospices Civils de Lyon Hopital E Herriot  Lyon France"},{"name":"Digestive Physiology Lyon I University  Lyon France"},{"name":"LabTAU, INSERM, Universit\u00e9 Lyon 1 Univ Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0532-3135","authenticated-orcid":false,"given":"Stefano","family":"Siboni","sequence":"additional","affiliation":[{"name":"Department of General and Emergency Surgery IRCCS Policlinico San Donato  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6802-2121","authenticated-orcid":false,"given":"Frank","family":"Zerbib","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, CHU de Bordeaux, Centre M\u00e9dico\u2010Chirurgical Magellan H\u00f4pital Haut\u2010L\u00e9v\u00eaque, Universit\u00e9 de Bordeaux, INSERM CIC 1401  Bordeaux France"}],"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":"Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology University of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14058","article-title":"Esophageal Motility Disorders on High\u2010Resolution Manometry: Chicago Classification Version 4.0(\u00a9)","volume":"33","author":"Yadlapati R.","year":"2021","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"i","DOI":"10.3310\/hta2030","article-title":"Consensus Development Methods, and Their Use in Clinical Guideline Development","volume":"2","author":"Murphy M. K.","year":"1998","journal-title":"Health Technology Assessment"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doae006"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE Guidelines: 3. Rating the Quality of Evidence","volume":"64","author":"Balshem H.","year":"2011","journal-title":"Journal of Clinical Epidemiology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.70431"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/nmo.12477","article-title":"The Chicago Classification of Esophageal Motility Disorders, v3.0","volume":"27","author":"Kahrilas P. J.","year":"2015","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1016\/j.cgh.2019.01.024","article-title":"Upright Integrated Relaxation Pressure Facilitates Characterization of Esophagogastric Junction Outflow Obstruction","volume":"17","author":"Triggs J. R.","year":"2019","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.1016\/S0016-5085(25)04080-6","article-title":"Tu1288: An Upright IRP >\u200915\u2009mm Hg Reduces Additional Testing in Patients With Clinically Conclusive Diagnosis of Esophagogastric Junction Outflow Obstruction","volume":"169","author":"Rusu R. I.","year":"2025","journal-title":"Gastroenterology"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/apt.15658","article-title":"Prospective Serial Diagnostic Study: The Effects of Position and Provocative Tests on the Diagnosis of Oesophageal Motility Disorders by High\u2010Resolution Manometry","volume":"51","author":"Misselwitz B.","year":"2020","journal-title":"Alimentary Pharmacology & Therapeutics"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14120","article-title":"Chicago Classification Version 4.0(\u00a9) Technical Review: Update on Standard High\u2010Resolution Manometry Protocol for the Assessment of Esophageal Motility","volume":"33","author":"Fox M. R.","year":"2021","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.17101"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"280","DOI":"10.14309\/ajg.0000000000000988","article-title":"The Clinical Relevance of Manometric Esophagogastric Junction Outflow Obstruction Can be Determined Using Rapid Drink Challenge and Solid Swallows","volume":"116","author":"Sanagapalli S.","year":"2021","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/S2468-1253(17)30148-6","article-title":"Diagnostic Yield of High\u2010Resolution Manometry With a Solid Test Meal for Clinically Relevant, Symptomatic Oesophageal Motility Disorders: Serial Diagnostic Study","volume":"2","author":"Ang D.","year":"2017","journal-title":"Lancet Gastroenterology & Hepatology"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.13668","article-title":"Pharmacologic Interrogation of Patients With Esophagogastric Junction Outflow Obstruction Using Amyl Nitrite","volume":"31","author":"Babaei A.","year":"2019","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1007\/s11605-009-0975-7","article-title":"Functional Esophagogastric Junction Obstruction With Intact Peristalsis: A Heterogeneous Syndrome Sometimes Akin to Achalasia","volume":"13","author":"Scherer J. R.","year":"2009","journal-title":"Journal of Gastrointestinal Surgery"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.cgh.2015.12.041","article-title":"Functional and Anatomic Esophagogastic Junction Outflow Obstruction: Manometry, Timed Barium Esophagram Findings, and Treatment Outcomes","volume":"14","author":"Clayton S. B.","year":"2016","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1038\/ajg.2016.1","article-title":"High\u2010Resolution Manometry Improves the Diagnosis of Esophageal Motility Disorders in Patients With Dysphagia: A Randomized Multicenter Study","volume":"111","author":"Roman S.","year":"2016","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13061"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.13293","article-title":"Rapid Drink Challenge Test During Esophageal High Resolution Manometry in Patients With Esophago\u2010Gastric Junction Outflow Obstruction","volume":"30","author":"Biasutto D.","year":"2018","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14555","article-title":"Major Mixed Motility Disorders: An Important Subset of Esophagogastric Junction Outflow Obstruction","volume":"35","author":"Leopold A. R.","year":"2023","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_22_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14467","article-title":"From Chicago Classification v3.0 to v4.0: Diagnostic Changes and Clinical Implications","volume":"35","author":"Sallette M.","year":"2023","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1016\/j.dld.2025.04.044","article-title":"Esophageal Motility Disorders Among Elderly Patients: An International Multicenter Study","volume":"57","author":"Visaggi P.","year":"2025","journal-title":"Digestive and Liver Disease"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.13924","article-title":"High\u2010Resolution Manometry in the Upright Position Could Improve the Manometric Evaluation of Morbidly Obese Patients With Esophagogastric Junction Outflow Obstruction","volume":"32","author":"Su H.","year":"2020","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_25_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14929","article-title":"Effect of Hiatal Hernia and Esophagogastric Junction Morphology on Esophageal Motility: Evidence From High\u2010Resolution Manometry Studies","volume":"36","author":"Kayali S.","year":"2024","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doae108"},{"key":"e_1_2_11_27_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.oraloncology.2025.107219","article-title":"Dysphagia in Head and Neck Cancer Patients With Evidence of Esophageal Dysmotility on Manometry","volume":"162","author":"Meeker B. S. M. O.","year":"2025","journal-title":"Oral Oncology"},{"key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/nmo.12708","article-title":"Characterization and Follow\u2010Up of Esophagogastric Junction Outflow Obstruction Detected by High Resolution Manometry","volume":"28","author":"P\u00e9rez\u2010Fern\u00e1ndez M. T.","year":"2016","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/nmo.13105","article-title":"The Clinical Significance of Esophagogastric Junction Outflow Obstruction and Hypercontractile Esophagus in High Resolution Esophageal Manometry","volume":"29","author":"Schupack D.","year":"2017","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_30_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14709","article-title":"Esophageal Anatomy and Physiology Vary Across Spastic and Non\u2010Spastic Phenotypes of Disorders of Esophagogastric Junction Outflow","volume":"36","author":"Vahedi F.","year":"2024","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_31_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/dote\/dox004","article-title":"Clinical Presentation and Disease Course of Patients With Esophagogastric Junction Outflow Obstruction","volume":"30","author":"Lynch K. L.","year":"2017","journal-title":"Diseases of the Esophagus"},{"key":"e_1_2_11_32_1","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1111\/nmo.12625","article-title":"Characterization of Idiopathic Esophagogastric Junction Outflow Obstruction","volume":"27","author":"Hoeij F. B.","year":"2015","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_33_1","doi-asserted-by":"crossref","first-page":"344","DOI":"10.5056\/jnm16041","article-title":"Esophagogastric Junction Outflow Obstruction Transformed to Type II Achalasia","volume":"22","author":"Shin I. S.","year":"2016","journal-title":"J Neurogastroenterol Motil"},{"key":"e_1_2_11_34_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14058","article-title":"Esophageal Motility Disorders on High\u2010Resolution Manometry: Chicago Classification Version 4.0((c))","volume":"33","author":"Yadlapati R.","year":"2021","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_35_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/nyas.15362","article-title":"The Conundrum of Esophagogastric Junction Outflow Obstruction: Answers to Key Clinical Questions","volume":"1549","author":"Lynch K. L.","year":"2025","journal-title":"Annals of the New York Academy of Sciences"},{"key":"e_1_2_11_36_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14193","article-title":"Esophagogastric Junction Outflow Obstruction","volume":"33","author":"Bredenoord A. J.","year":"2021","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_37_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.14309\/ajg.0000000000001980","article-title":"Functional Lumen Imaging Probe Panometry Helps Identify Clinically Relevant Esophagogastric Junction Outflow Obstruction Per Chicago Classification v4.0","volume":"118","author":"Carlson D. A.","year":"2023","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2025.01.234"},{"key":"e_1_2_11_39_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s11894-024-00928-6","article-title":"Esophagogastric Junction Outflow Obstruction (EGJOO): A Manometric Phenomenon or Clinically Impactful Problem","volume":"26","author":"Bach L.","year":"2024","journal-title":"Current Gastroenterology Reports"},{"key":"e_1_2_11_40_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s11894-020-0743-0","article-title":"Esophagogastric Junction Outflow Obstruction: Current Approach to Diagnosis and Management","volume":"22","author":"Zikos T. A.","year":"2020","journal-title":"Current Gastroenterology Reports"},{"key":"e_1_2_11_41_1","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1038\/ajg.2017.370","article-title":"Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non\u2010Achalasia Dysphagia","volume":"113","author":"Blonski W.","year":"2018","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13093"},{"key":"e_1_2_11_43_1","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1111\/nmo.12814","article-title":"Anatomic Abnormalities Are Common Potential Explanations of Manometric Esophagogastric Junction Outflow Obstruction","volume":"28","author":"DeLay K.","year":"2016","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_44_1","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/ueg2.70062","article-title":"Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility","volume":"13","author":"Mari A.","year":"2025","journal-title":"United European Gastroenterology Journal"},{"key":"e_1_2_11_45_1","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.giec.2024.12.006","article-title":"The Esophageal Mucosa: Clues to Underlying Pathology","volume":"35","author":"Visaggi P.","year":"2025","journal-title":"Gastrointestinal Endoscopy Clinics of North America"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2024.02.005"},{"key":"e_1_2_11_47_1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2147\/ITT.S276869","article-title":"Optimal Assessment, Treatment, and Monitoring of Adults With Eosinophilic Esophagitis: Strategies to Improve Outcomes","volume":"13","author":"Visaggi P.","year":"2024","journal-title":"ImmunoTargets and Therapy"},{"key":"e_1_2_11_48_1","first-page":"23","article-title":"Eosinophilic Esophagitis: Novel Concepts Regarding Pathogenesis and Clinical Manifestations","volume":"68","author":"Scium\u00e8 G. D.","year":"2022","journal-title":"Minerva Gastroenterologica (Torino)"},{"key":"e_1_2_11_49_1","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.dld.2022.01.003","article-title":"Systematic Review: Esophageal Motility Patterns in Patients With Eosinophilic Esophagitis","volume":"54","author":"Visaggi P.","year":"2022","journal-title":"Digestive and Liver Disease"},{"key":"e_1_2_11_50_1","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1016\/j.cgh.2020.07.056","article-title":"Achalasia and Obstructive Motor Disorders Are Not Uncommon in Patients With Eosinophilic Esophagitis","volume":"19","author":"Ghisa M.","year":"2020","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_51_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.gie.2024.02.020","article-title":"An Endoscopic Scoring System for Achalasia: The CARS Score","volume":"100","author":"Ellison A.","year":"2024","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000002288"},{"key":"e_1_2_11_53_1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/S0016-5107(94)70044-3","article-title":"Endoscopic Appearance of the Lower Esophageal Sphincter in Achalasia: A Diagnostic Sign","volume":"40","author":"Levine M. L.","year":"1994","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_54_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.54685","article-title":"Esophageal Candida Infection and Esophageal Cancer Risk in Patients With Achalasia","volume":"8","author":"Guo X.","year":"2025","journal-title":"JAMA Network Open"},{"key":"e_1_2_11_55_1","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.14309\/ajg.0000000000001532","article-title":"Classifying Esophageal Motility by FLIP Panometry: A Study of 722 Subjects With Manometry","volume":"116","author":"Carlson D. A.","year":"2021","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_56_1","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.14309\/ajg.0000000000000734","article-title":"ACG Clinical Guidelines: Clinical Use of Esophageal Physiologic Testing","volume":"115","author":"Gyawali C. P.","year":"2020","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_57_1","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1053\/j.gastro.2025.05.011","article-title":"AGA Clinical Practice Update on Incorporating Functional Lumen Imaging Probe Into Esophageal Clinical Practice: Expert Review","volume":"169","author":"Nguyen A. D.","year":"2025","journal-title":"Gastroenterology"},{"key":"e_1_2_11_58_1","doi-asserted-by":"crossref","first-page":"e1250","DOI":"10.1016\/j.cgh.2021.06.040","article-title":"Validation of Clinically Relevant Thresholds of Esophagogastric Junction Obstruction Using FLIP Panometry","volume":"20","author":"Carlson D. A.","year":"2022","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_59_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.14309\/ajg.0000000000001980","article-title":"FLIP Panometry Helps Identify Clinically Relevant Esophagogastric Junction Outflow Obstruction Per Chicago Classification v4.0","volume":"118","author":"Carlson D. A.","year":"2023","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doab077"},{"key":"e_1_2_11_61_1","doi-asserted-by":"crossref","first-page":"E1137","DOI":"10.1055\/a-1198-4643","article-title":"Esophageal Peroral Endoscopic Myotomy (POEM) for Treatment of Esophagogastric Junction Outflow Obstruction: Results From the First Prospective Trial","volume":"8","author":"Ichkhanian Y.","year":"2020","journal-title":"Endosc Int Open"},{"key":"e_1_2_11_62_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.14309\/ajg.0000000000001938","article-title":"The Tailored Approach to Manometric Esophagogastric Junction Outflow Obstruction: Treat the Clinical Diagnosis, Not the Manometry Pattern","volume":"118","author":"Carlson D. A.","year":"2023","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.70450"},{"key":"e_1_2_11_64_1","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.amjsurg.2020.11.028","article-title":"Is Barium Esophagram Enough? Comparison of Esophageal Motility Found on Barium Esophagram to High Resolution Manometry","volume":"221","author":"Zambito G.","year":"2021","journal-title":"American Journal of Surgery"},{"key":"e_1_2_11_65_1","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/j.1442-2050.2005.00460.x","article-title":"Timed Barium Esophagogram in the Assessment of Patients With Achalasia: Reproducibility and Observer Variation","volume":"18","author":"Kostic S.","year":"2005","journal-title":"Diseases of the Esophagus"},{"key":"e_1_2_11_66_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14928","article-title":"The History and Use of the Timed Barium Esophagram in Achalasia, Esophagogastric Junction Outflow Obstruction, and Esophageal Strictures","volume":"37","author":"Blonski W.","year":"2025","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_67_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14322","article-title":"Timed Barium Swallow: Esophageal Stasis Varies Markedly Across Subtypes of Esophagogastric Junction Obstruction","volume":"34","author":"Sanagapalli S.","year":"2022","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_68_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1053\/j.gastro.2025.02.013","article-title":"Diagnostic Accuracy of Timed Barium Esophagram for Achalasia","volume":"169","author":"Fass O. Z.","year":"2025","journal-title":"Gastroenterology"},{"key":"e_1_2_11_69_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/S1542-3565(04)00123-5","article-title":"Predictors of Outcome of Pneumatic Dilation in Achalasia","volume":"2","author":"Farhoomand K.","year":"2004","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_70_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.cgh.2012.10.015","article-title":"A Comparison of Symptom Severity and Bolus Retention With Chicago Classification Esophageal Pressure Topography Metrics in Patients With Achalasia","volume":"11","author":"Nicodeme F.","year":"2013","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_71_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1038\/ajg.2012.318","article-title":"Esophageal Stasis on a Timed Barium Esophagogram Predicts Recurrent Symptoms in Patients With Long\u2010Standing Achalasia","volume":"108","author":"Rohof W. O.","year":"2013","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_72_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.13522","article-title":"Pneumatic Dilation Improves Esophageal Emptying and Symptoms in Patients With Idiopathic Esophago\u2010Gastric Junction Outflow Obstruction","volume":"31","author":"Clayton S. B.","year":"2019","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_73_1","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/nyas.14412","article-title":"How to Approach Esophagogastric Junction Outflow Obstruction?","volume":"1481","author":"Patcharatrakul T.","year":"2020","journal-title":"Annals of the New York Academy of Sciences"},{"key":"e_1_2_11_74_1","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1007\/s11605-023-05844-0","article-title":"Peroral Endoscopic Myotomy (POEM) and Laparoscopic Heller Myotomy With Dor Fundoplication for Esophagogastric Junction Outflow Obstruction (EGJOO): A Comparison of Outcomes and Impact on Physiology","volume":"27","author":"Sarici I. S.","year":"2023","journal-title":"Journal of Gastrointestinal Surgery"},{"key":"e_1_2_11_75_1","first-page":"131","article-title":"Diagnosis and Management of Esophagogastric Junction Outflow Obstruction","volume":"16","author":"Beveridge C.","year":"2020","journal-title":"Gastroenterol Hepatol (N Y)"},{"key":"e_1_2_11_76_1","doi-asserted-by":"crossref","first-page":"AB548","DOI":"10.1016\/j.gie.2018.04.2191","article-title":"Tu1161 Clinical Outcomes of Patients With Primary Esophagogastric Junction Outflow Obstruction (EGJOO): Management at a Single Tertiary Referral Center","volume":"87","author":"Klair J. S.","year":"2018","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_77_1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/s12876-023-02787-3","article-title":"Phosphodiesterase 5 (PDE\u20105) Inhibitors (Sildenafil, Tadalafil, and Vardenafil) Effects on Esophageal Motility: A Systematic Review","volume":"23","author":"Shafiee A.","year":"2023","journal-title":"BMC Gastroenterology"},{"key":"e_1_2_11_78_1","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1111\/j.1365-2036.2011.04978.x","article-title":"Systematic Review: The Treatment of Noncardiac Chest Pain With Antidepressants","volume":"35","author":"Nguyen T. M.","year":"2012","journal-title":"Alimentary Pharmacology & Therapeutics"},{"key":"e_1_2_11_79_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1365-2982.2010.01604.x","article-title":"Botulinum Toxin Injection in Dysphagia Syndromes With Preserved Esophageal Peristalsis and Incomplete Lower Esophageal Sphincter Relaxation","volume":"23","author":"Porter R. F.","year":"2011","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_80_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doae082"},{"key":"e_1_2_11_81_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14859","article-title":"The Functional Lumen Imaging Probe Contractile Response Pattern Is the Best Predictor of Botulinum Toxin Response in Esophagogastric Junction Outflow Obstruction","volume":"36","author":"Biermann M.","year":"2024","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_82_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.70053","article-title":"Functional Lumen Imaging Probe Measurement Post\u2010Pneumatic Dilation in Clinically Relevant Esophagogastric Junction Outlet Obstruction","volume":"37","author":"Miller J. D.","year":"2025","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_83_1","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.gie.2022.09.032","article-title":"Expanding the Role of Pneumatic Dilation for Nonachalasia Patients: A Comparative Study","volume":"97","author":"Desai N.","year":"2023","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_84_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doae036"},{"key":"e_1_2_11_85_1","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","article-title":"ACG Clinical Guidelines: Diagnosis and Management of Achalasia","volume":"115","author":"Vaezi M. F.","year":"2020","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_86_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41572-022-00356-8","article-title":"Achalasia","volume":"8","author":"Savarino E.","year":"2022","journal-title":"Nature Reviews Disease Primers"},{"key":"e_1_2_11_87_1","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1111\/den.70018","article-title":"Clinical Course of Blown\u2010Out Myotomy After Peroral Endoscopic Myotomy in Patients With Achalasia\u2010Related Esophageal Motility Disorders","volume":"37","author":"Tanabe H.","year":"2025","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_11_88_1","doi-asserted-by":"crossref","first-page":"5491","DOI":"10.1007\/s00464-026-12950-y","article-title":"Prevalence and Clinical Characteristics of Blown\u2010Out Myotomy After E\u2010POEM for Achalasia: A Systematic Review and Meta\u2010Analysis","volume":"40","author":"Kagzi Y.","year":"2026","journal-title":"Surgical Endoscopy"},{"key":"e_1_2_11_89_1","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.cgh.2020.08.048","article-title":"Per\u2010Oral Endoscopic Myotomy for Esophagogastric Junction Outflow Obstruction: A Multicenter Pilot Study","volume":"19","author":"Jacobs C. C.","year":"2021","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_90_1","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s10388-024-01076-6","article-title":"Efficacy and Safety of Per\u2010Oral Endoscopic Myotomy in Non\u2010Achalasia Esophageal Motility Disorders: A Systematic Review and Meta\u2010Analysis","volume":"21","author":"Puri R.","year":"2024","journal-title":"Esophagus"},{"key":"e_1_2_11_91_1","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.gie.2023.12.034","article-title":"Peroral Endoscopic Myotomy for Spastic Esophageal Dysmotility Among Opioid Users: A Multicenter Propensity Score Matching Study","volume":"99","author":"Fawwaz B. B.","year":"2024","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_92_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000002373"},{"key":"e_1_2_11_93_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S2468-1253(25)00012-3","article-title":"Per\u2010Oral Endoscopic Myotomy Versus Laparoscopic Heller's Myotomy Plus Dor Fundoplication in Patients With Idiopathic Achalasia: 5\u2010Year Follow\u2010Up of a Multicentre, Randomised, Open\u2010Label, Non\u2010Inferiority Trial","volume":"10","author":"Hugova K.","year":"2025","journal-title":"Lancet Gastroenterology & Hepatology"},{"key":"e_1_2_11_94_1","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.14309\/ajg.0000000000002816","article-title":"Focal Distal Esophageal Dilation (Blown\u2010Out Myotomy) After Achalasia Treatment: Prevalence and Associated Symptoms","volume":"119","author":"Kuipers T.","year":"2024","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_95_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14747","article-title":"Fifteen\u2010Year Symptomatic Outcome of Patients With Nonactionable Motor Findings on High\u2010Resolution Manometry","volume":"36","author":"Peravali R.","year":"2024","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_96_1","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1007\/s11605-021-05021-1","article-title":"Laparoscopic Heller\u2010Dor Is an Effective Treatment for Esophageal\u2010Gastric Junction Outflow Obstruction","volume":"25","author":"Salvador R.","year":"2021","journal-title":"Journal of Gastrointestinal Surgery"},{"key":"e_1_2_11_97_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14729","article-title":"Frequent Discrepancies Among Diagnostic Tests for Detecting Lower Esophageal Sphincter\u2010Related Obstruction","volume":"36","author":"Reddy C. A.","year":"2024","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_98_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14116","article-title":"Evaluating Esophageal Motility Beyond Primary Peristalsis: Assessing Esophagogastric Junction Opening Mechanics and Secondary Peristalsis in Patients With Normal Manometry","volume":"33","author":"Carlson D. A.","year":"2021","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_99_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14321","article-title":"Spastic Secondary Contractile Patterns Identified by FLIP Panometry in Symptomatic Patients With Unremarkable High\u2010Resolution Manometry","volume":"34","author":"Nguyen A. D.","year":"2022","journal-title":"Neurogastroenterology and Motility"},{"key":"e_1_2_11_100_1","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.cgh.2022.02.047","article-title":"Rapid Drink Challenge During High Resolution Manometry for Evaluation of Esophageal Emptying in Treated Achalasia","volume":"21","author":"Penagini R.","year":"2022","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_101_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.13586","article-title":"Achalasia Diagnosed Despite Normal Integrated Relaxation Pressure Responds Favorably to Therapy","volume":"31","author":"Sanagapalli S.","year":"2019","journal-title":"Neurogastroenterology and Motility"}],"container-title":["Neurogastroenterology &amp; Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.70466","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nmo.70466","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.70466","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:45:33Z","timestamp":1792467933000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.70466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":100,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/nmo.70466"],"URL":"https:\/\/doi.org\/10.1111\/nmo.70466","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-08-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70466"}}