{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:08:22Z","timestamp":1784045302788,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Patients with absent contractility (AC) often suffer from either reflux or dysphagia. It remains unclear what factors determine which phenotype patients present with. We sought to evaluate if high-resolution manometry metrics, especially integrated relaxation pressure (IRP), could explain this. Methods: Cases of AC from three medical centers were reviewed for demographic, clinical, and manometric data. Cases with an IRP between 10\u201315 mmHg or subsequent diagnosis of achalasia were excluded. Results: 69 subjects were included (mean age 56.1; 71% female). A total of 41 (59.4%) were reflux-predominant. The reflux-predominant group was younger (51.1 vs. 63.5, p = 0.002) and had lower median LES basal pressures (7.5 vs. 12.5 mmHg, p = 0.014) and IRP values (1.5 vs. 5.6 mmHg, p &lt; 0.001) compared to the dysphagia group. When divided into tertiles, the trend in symptoms between LES basal pressure tertiles was not significant. However, the trend for IRP was significant (p &lt; 0.001). For example, in the lowest IRP tertile, 91.3% of subjects were reflux-predominant compared to only 26.1% in the highest tertile, while the dysphagia-predominant group increased from 8.7% to 73.9%. In a regression model controlling for age and using IRP tertile 1 as the reference, having an IRP in tertile 2 increased the likelihood of having dysphagia-predominant disease by 7, while being in tertile 3 increased the likelihood by 22. Conclusions: IRP helps distinguish between the reflux-predominant and dysphagia-predominant phenotypes of AC. This may have therapeutic clinical consequences as procedures such as fundoplication to tighten the LES may benefit patients with reflux and a low IRP, while procedures like peroral endoscopic myotomy (POEM) to disrupt the LES may benefit patients with dysphagia and a relatively high IRP.<\/jats:p>","DOI":"10.3390\/jcm11216287","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T23:50:28Z","timestamp":1666741828000},"page":"6287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Integrated Relaxation Pressure (IRP) Distinguishes between Reflux-Predominant and Dysphagia-Predominant Phenotypes of Esophageal \u201cAbsent Contractility\u201d"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7879-3966","authenticated-orcid":false,"given":"Daniel L.","family":"Cohen","sequence":"first","affiliation":[{"name":"The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1343-8779","authenticated-orcid":false,"given":"Anton","family":"Bermont","sequence":"additional","affiliation":[{"name":"The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vered","family":"Richter","sequence":"additional","affiliation":[{"name":"The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narjes","family":"Azzam","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Nazareth EMMS Hospital, Nazareth 16100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haim","family":"Shirin","sequence":"additional","affiliation":[{"name":"The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6477-2849","authenticated-orcid":false,"given":"Ram","family":"Dickman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6828-4738","authenticated-orcid":false,"given":"Amir","family":"Mari","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Nazareth EMMS Hospital, Nazareth 16100, Israel"},{"name":"Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e14058","DOI":"10.1111\/nmo.14058","article-title":"Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0\u00a9","volume":"33","author":"Yadlapati","year":"2021","journal-title":"Neurogastroenterol. 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