ArticleNeurogastroenterology and motility2025
Assessment of Esophagogastric Junction Barrier Function With the Supine-Upright Transition of the Chicago Classification Protocol.
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 2 papers.
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Who cites it
2 citing papers in PubMed.
- PPI-Refractory GERD in Systemic Sclerosis Is Driven by Distinct Esophageal and Gastric Motility Abnormalities.medRxiv : the preprint server for health sciences · 2026Article
- Gatherings in Esophagology: Innovations and Future Directions in the Diagnosis and Management of Reflux Disease.Annals of the New York Academy of Sciences · 2026Article
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Authors and funding
18 authors.
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No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND &
aimsThe straight leg raise (SLR) is a provocative maneuver used to assess the esophagogastric junction (EGJ) barrier function during high-resolution manometry (HRM) and is part of the Milan Score (MS). The Chicago Classification 4.0 (CCv4.0) protocol requires patients to perform a supine-upright transition (SUT), increasing intra-abdominal pressure (IAP). The aim of this study was to compare the SUT and SLR maneuvers for efficacy in increasing IAP and in predicting pathologic gastroesophageal reflux disease (GERD).
methodsConsecutive adult patients with persistent GERD symptoms undergoing HRM and pH-impedance were prospectively enrolled. After completion of the supine swallows of the CCv4.0 protocol, the SLR maneuver was performed and the patients were asked to get up to the upright position (SUT). IAP and intra-esophageal pressure (IEP) were recorded at baseline and during the maneuvers. GERD was defined as acid exposure time > 6% according to Lyon 2.0.
resultsAmong the 110 patients included (age 55 years; 59.1% female, BMI 25.4 kg/m
conclusionsSUT is comparable to SLR, with higher sensitivity but lower specificity. When both are concordant, the SUT can strengthen confidence in SLR and increase the accuracy of the Milan Score.
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