Clinical Characteristics of Patients With Ineffective Esophageal Motility by Chicago Classification Version 4.0 Compared to Chicago Classification Version 3.0

Abstract

Background/AimsChicago classification version 4.0 (CCv4.0) of esophageal motility disorders developed a more stringent diagnostic criteria for ineffective esophageal motility (IEM) than version 3.0. We studied the implications of the new diagnostic criteria on the prevalence of IEM, and clinically characterized and compared the population of patients who no longer meet diagnostic criteria for IEM to those who retain the diagnosis. MethodsWe included all consecutively performed high-resolution esophageal impedance manometries from 2014 to 2021. Three cohorts of patients with IEM were created: Patients with IEM by Chicago classification version 3.0 (CCv3.0; CC3 group), by CCv4.0 only (CC4 group), and by CCv3.0 who are now considered normal (Normal group). Demographics, manometric and reflux parameters, and clinical outcomes were compared. ResultsA total of 594 manometries were analyzed. Of those, 66 (11.1%) met criteria for IEM by CCv3.0 (CC3), 41 (62.0%) retained an IEM diagnosis using CCv4.0 criteria (CC4), while 25 (38.0%) patients no longer met criteria for IEM (Normal). The CC4 group had higher esophageal acid exposure, especially supine (% time -18.9% vs 2.2%; P = 0.005), less adequate peristaltic reserve (22.0% vs 88.0%; P = 0.003), and higher Demeester score (49.0 vs 21.2; P = 0.017) compared to the Normal group. There was no difference in bolus clearance between the groups. ConclusionsIEM under CCv4.0 has a stronger association with pathologic reflux, especially supine reflux, and inadequate peristaltic reserve, but impairment in bolus clearance is unchanged when compared with IEM diagnosed based on CCv3.0. Further studies are required to determine the implications of these findings on management strategies.

The prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma

“…42 Chicago classification version 4 (Table 1) was used for the analysis and interpretation of the esophageal manometric data and motility disorders. 43 Readings from both the resting and the 10 wet swallows were analyzed. The main metrics in EHRIM were the integrated relaxation pressure (IRP) of the lower esophageal sphincter (LES), which reflects deglutitive relaxation across the LES, and the distal contractile integral (DCI), which is a pressure integral representing the strength of esophageal contraction.…”

Esophageal motility disorder – has Chicago classification v4.0 simplified our management?

“…Supporting tests like impedance or barium esophagram may be required. The new criteria identified IEM more likely associated with GERD [8,9 ▪ ,10].…”

“…Some researchers have shown that patients with short-latency spasm do not differ significantly from those with normal latency spasm in terms of dysphagia symptoms [21]. (6) The CC renders no opinion on whether or how to interpret some commonly observed findings like absent LES tone, retrograde esophageal contractions, and secondary contractions. (7) Because the CC has yet to incorporate concurrent impedance data into the classification system it remains uninformative as to criteria for diagnosing conditions such as rumination, aerophagia, and supragastric belching.…”

Diagnosis of Ineffective Esophageal Motility According to Chicago Classification Version 4.0: More Stringent Criteria, but Also New Difficulties

“…TO THE EDITOR: We read with great interest the study by Kurin et al 1 about the clinical characteristics of patients with ineffective esophageal motility (IEM) comparing diagnosis according to the Chicago classification version 3.0 (CC v3.0) versus CC v4.0.…”

“…Kurin et al 1 demonstrated that 41 patients out of the 66 patients selected with IEM at high-resolution manometry (HRM) according to CC v3.0 also met the criteria for IEM according to the new CC v4.0. This subgroup of 41 patients had higher acid exposure time (especially in the supine position), lower adequate peristaltic reserve and higher Demeester score.…”