ArticleNeurogastroenterology and motility2021
Chicago Classification update (v4.0): Technical review of high-resolution manometry metrics for EGJ barrier function.
Article in Neurogastroenterology and motility, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- Pooled it
- Diagnostic value of real-time dynamic gastric contrast ultrasound for hiatal hernia.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- Mean Basal Esophagogastric Junction Pressure Is a Better High-resolution Manometry Predictor of Gastroesophageal Reflux Disease Than Esophagogastric Junction Contractile Integral.Journal of neurogastroenterology and motility · 2026Article
- Impact of central obesity on esophageal motility and mucosal barrier function based on conventional CT evaluation.Frontiers in medicine · 2026Article
- The "ABCD" framework for assessment: a task-oriented approach to reconcile multimodal diagnostic discordance.Frontiers in medicine · 2026Review
- The Milan Score Predicts Objective Gastroesophageal Reflux Disease in Patients With Type 2 Esophagogastric Junction.Neurogastroenterology and motility · 2026Article
- Assessment of Esophagogastric Junction Barrier Function With the Supine-Upright Transition of the Chicago Classification Protocol.Neurogastroenterology and motility · 2025Article
- Combined Lyon and Milan Scores Predict Gerd Management Outcome Better Than Either Score Alone or Their Individual Components.Alimentary pharmacology & therapeutics · 2025Article
- Correlation between the type of esophagogastric junction and refractory reflux esophagitis.International journal of clinical and experimental pathology · 2025Article
- Normative high resolution esophageal manometry values in asymptomatic patients with obesity.Neurogastroenterology and motility · 2024Article
- Utilizing Esophageal Motility Tests in Diagnosing and Evaluating Gastroesophageal Reflux Disease.Diagnostics (Basel, Switzerland) · 2024Review
- Esophageal Infusion of Menthol Does Not Affect Esophageal Motility in Patients with Gastroesophageal Reflux Disease.Dysphagia · 2024Article
- The Milan score: A novel manometric tool for a more efficient diagnosis of gastro-esophageal reflux disease.United European gastroenterology journal · 2024Article
- Selective dysfunction of the crural diaphragm in patients with chronic restrictive and obstructive lung disease.Neurogastroenterology and motility · 2024Article
- Esophageal Motility Patterns in Paraesophageal Hernia Patients Compared to Sliding Hiatal Hernia: Bigger Is Not Better.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2023Article
- Identifying hiatal hernia with impedance planimetry during esophageal distension testing.Neurogastroenterology and motility · 2023Article
- Modified Peroral Endoscopic Myotomy Technique for Type II Achalasia: A Multicenter Retrospective Study.Gastroenterology research and practice · 2022Article
- How Updates in Chicago Classification Impact Clinical Practice.Foregut (Thousand Oaks, Calif.) · 2021Article
Corrections and comments
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Authors and funding
10 authors at 8 institutions in 6 countries.
Funding
Abstract
Esophagogastric junction (EGJ) barrier function is of fundamental importance in the pathophysiology of gastroesophageal reflux disease. Impaired EGJ barrier function leads to excessive distal esophageal acid exposure or, in severe cases, esophagitis. Hence, proposed high-resolution manometry (HRM) metrics assessing EGJ integrity are clinically important and were a focus of the Chicago Classification (CC) working group for inclusion in CC v4.0. However, the EGJ is a complex sphincter comprised of both crural diaphragm (CD) and lower esophageal sphincter (LES) component, each of which is subject to independent physiological control mechanisms and pathophysiology. No single metric can capture all attributes of EGJ barrier function. The working group considered several potential metrics of EGJ integrity including LES-CD separation, the EGJ contractile integral (EGJ-CI), the respiratory inversion point (RIP), and intragastric pressure. Strong recommendations were made regarding LES-CD separation as indicative of hiatus hernia, although the numerical threshold for defining hiatal hernia was not agreed upon. There was no agreement on the significance of the RIP, only that it could localize either above the LES or between the LES and CD in cases of hiatus hernia. There was agreement on how to measure the EGJ-CI and that it should be referenced to gastric pressure in units of mmHg cm, but the numerical threshold indicative of a hypotensive EGJ varied widely among reports and was not agreed upon. Intragastric pressure was endorsed as an important metric worthy of further study but there was no agreement on a numerical threshold indicative of abdominal obesity.
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