Background <p>Ineffective esophageal motility (IEM) is observed in patients with gastroesophageal reflux disease (GERD) and healthy individuals, yet its underlying pathogenesis remains poorly understood. The esophagogastric junction contractile integral (EGJ-CI) is a recently introduced metric designed to assess the contractile function of the esophagogastric junction (EGJ) barrier. This study aimed at assessing the function of the EGJ complex in patients with IEM to understand its role in disease pathogenesis.</p> Methods <p>Total 157 participants who underwent high-resolution manometry (HRM) were selected and diagnosed based on the Chicago Classification version 4.0. Of these, 34 participants were assigned to the IEM group and 34 were included in the normal motility group using propensity score matching. HRM metrics, including the EGJ-CI, were compared between groups and a correlation analysis was performed to evaluate relationships between EGJ-CI and other HRM metrics.</p> Results <p>Patients in the IEM group, with higher reflux burden on gastroscopy and reflux monitoring, exhibited a significantly lower average distal contractile integral (DCI) than those in the normal motility group. The EGJ-CI was also reduced in the IEM group compared to the normal motility group when excluding participants with GERD (37.96 [16.14, 49.36] mmHg·cm vs. 45.81 [33.07, 63.09] mmHg·cm). Furthermore, a positive correlation was identified between average DCI (<i>r</i> = 0.275), median integrated relaxation pressure (IRP) (<i>r</i> = 0.627) and EGJ-CI.</p> Conclusions <p>Patients with IEM demonstrated a reduced EGJ-CI, independent of reflux burden, indicating an impaired EGJ complex barrier that may contribute to IEM pathogenesis.</p> Graphical Abstract <p></p>