Evidence map›Paper›PMID 40391471›Full record

ArticleNeurogastroenterology and motility2025

Fibrosis in the Hiatus of Esophagus in Patients With Primary Esophageal Motor Disorders: Radiomic Analysis.

Ravinder K Mittal, Anant Gupta, Jerry Fu, Paul Stark, Shreeya Candipali, Lixin Sun, Carlos Nemeh, Arshia Sharma, Ali Zifan

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurogastroenterology and motility, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Ravinder K MittalDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.ORCID https://orcid.org/0000-0001-5228-9617
Anant GuptaDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.
Jerry FuDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.
Paul StarkDepartment of Radiology, San Diego VA Medical Center, San Diego, California, USA.
Shreeya CandipaliDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.
Lixin SunDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.
Carlos NemehDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.
Arshia SharmaDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.
Ali ZifanDepartment of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.ORCID https://orcid.org/0000-0003-0272-7492

Funding

Novel Electrical Impedance Methodology to Understand Functional DysphagiaR56DK109376 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MITTAL, RAVINDER K., ZIFAN, ALI · 2023 to 2023
$682k
Hiatal Dysfunction in Achalasia EsophagusR56DK129451 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MITTAL, RAVINDER K. · 2021 to 2021
$663k
NIDDK NIH HHS R56 DK109376NIDDK NIH HHS R56 DK129451NIH HHS
6 · The paper itself

Abstract

introductionIn normal subjects, the esophagus and crus of the diaphragm slide relative to each other during esophageal peristalsis, which is not the case in patients with achalasia esophagus.

objectiveTo examine the tissue characteristics of the esophageal hiatus in patients with achalasia esophagus, high amplitude esophageal contractions (HAEC), esophagogastric junction outflow obstruction (EGJOO), and normal subjects using radiomics analysis of the CT images.

methodsA large number of medical records (1221 controls, 409 achalasia, 562 EGJOO, and 349 HAEC) were screened to identify subjects with a CT scan of the abdomen/chest in their record that met the pre-determined criteria. Using multiplanar rotation of CT images, the esophageal hiatus was visualized in a 2D plane. The grayscale intensity distributions (GSID) of the three regions of interest, i.e., (1) subcutaneous adipose tissue, (2) a posterior spine muscle (marker of fibro-connective tissue), and (3) esophageal hiatus were determined.

resultsNo differences in the mean GSID of subcutaneous adipose tissue and muscle were found among the four groups. On the other hand, the esophageal hiatus mean GSID was significantly higher in the three patient groups compared to controls. The GSIDs were higher in achalasia patients than in HAEC and EGJOO patients. The mean GSI of the hiatus was closer to that of the muscle with greater overlap between the hiatus and muscle in the three patient groups; the overlap was greater in achalasia as compared to HAEC and EGJOO patients.

conclusionA higher GSI of the hiatus with greater overlap between the hiatus and muscle suggests an increase in fibro-connective tissue in the esophageal hiatus of patients with primary esophageal motility disorders (EMD). We propose that fibrosis in the esophageal hiatus restricts axial separation between the LES and crural diaphragm, which may be important in the pathogenesis of esophageal motor disorders.

Indexed as

Esophageal AchalasiaEsophageal Motility DisordersEsophagusAdultAgedFemaleFibrosisHumansMaleMiddle AgedRadiomicsTomography, X-Ray Computedachalasia esophagusesophageal hiatusesophageal hiatus fibrosisesophageal motor disordersgrayscale intensity analysisphrenoesophageal fat padradiomic analysis

Identifiers

PMID40391471
PMCPMC12353943

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.