Comparison of motor diagnoses by Chicago Classification versions 2.0 and 3.0 on esophageal high‐resolution manometry

Abstract

SUMMARY Background The Chicago Classification (CC) uses high-resolution manometry (HRM) software tools to designate esophageal motor diagnoses. We evaluated changes in diagnostic designations between two CC versions, and determined motor patterns not identified by either version. Methods In this observational cohort study of consecutive patients undergoing esophageal HRM over a 6-year period, proportions meeting CC 2.0 and 3.0 criteria were segregated into esophageal outflow obstruction, hypermotility, and hypomotility disorders. Contraction wave abnormalities (CWA), and ‘normal’ cohorts were recorded. Symptom burden was characterized using dominant symptom intensity and global symptom severity. Motor diagnoses, presenting symptoms, and symptom burden were compared between CC 2.0 and 3.0, and in cohorts not meeting CC diagnoses. Results Of 2569 eligible studies, 49.9% met CC 2.0 criteria, but only 40.3% met CC 3.0 criteria (p<0.0001). Between CC 2.0 and 3.0, 82.8% of diagnoses were concordant. Discordance resulted from decreasing proportions of hypermotility (4.4%) and hypomotility (9.0%) disorders, and increase in ‘normal’ designations (13.0%); esophageal outflow obstruction showed the least variation between CC versions. Symptom burden was higher with CC 3.0 diagnoses (p≤0.005) but not with CC 2.0 diagnoses (p≥0.1). Within ‘normal’ cohorts for both CC versions, CWA were associated with higher likelihood of esophageal symptoms, especially dysphagia, regurgitation, and heartburn, compared to truly normal studies (p≤0.02 for each comparison). Conclusions Despite lower sensitivity, CC 3.0 identifies esophageal motor disorders with higher symptom burden compared to CC 2.0. CWA, which are associated with both transit and perceptive symptoms, are not well identified by either version.

Rapid drink challenge test during esophageal high resolution manometry in patients with esophago‐gastric junction outflow obstruction

“…Despite the improvement in the identification of esophageal motor disorders with higher symptom burden compared to the previous versions of the Chicago classification, there are still some categories of uncertain clinical significance …”

Esophageal Baseline Impedance From High-resolution Impedance Manometry Correlates With Mean Nocturnal Baseline Impedance From pH-impedance Monitoring

“…Prior to esophageal function testing at the performing institution, all patients completed symptom surveys to rate their dominant and secondary symptom frequency and severity on 5-point Likert scales, as well as esophageal global symptom severity (GSS) on 100-mm visual analog scales, as previously described. 4 , 5 , 23 , 24 Patients rate symptom frequency from 0 (no symptoms) to 4 (multiple daily episodes), and symptom severity from 0 (no symptoms) to 4 (very severe symptoms). Dominant symptom intensity (DSI) is then calculated as the product of symptom frequency and symptom severity (for a total score from 0 to 16).…”

Esophageal shortening after rapid drink test during esophageal high‐resolution manometry: A relevant finding?

“…15 The latest iteration of the Chicago Classification (CC) for esophageal motility disorders demonstrated an improvement in the identification of motor disorders with higher symptom burden compared to previous versions. 16,17 Provocative tests were developed to enhance diagnostic accuracy in patients with suspected motility disorders. [18][19][20] The rapid drink test (RDT, consisting of 200-ml free drinking in a sitting position) and test meal can be used during esophageal HRM.…”

“…The latest iteration of the Chicago Classification (CC) for esophageal motility disorders demonstrated an improvement in the identification of motor disorders with higher symptom burden compared to previous versions 16 , 17 …”