High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals

Rengarajan, Arvind; Rogers, Benjamin D.; Wong, Zhiqin; Tolone, Salvatore; Sifrim, Daniel; Serra, Jordi; Savarino, Edoardo; Roman, Sabine; Remes-Troche, José María; Ramos, Rosa; Serna, Julio; Pauwels, Ans; Leguízamo, Ana María; Lee, Yeong Yeh; Kawamura, Osamu; Hayat, Jamal; Hani, Albis; Gonlachanvit, Sutep; Cisternas, Daniel; Carlson, Dustin A.; Bor, Serhat; Bhatia, Shobna; Abrahão, Luiz; Pandolfino, John E.; Gyawali, C. Prakash

doi:10.1016/j.cgh.2020.10.052

Cited by 26 publications

(36 citation statements)

References 15 publications

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“… Threshold for median IRP in the supine position is 15 mmHg for Medtronic systems and 22 mmHg for Laborie/Diversatek systems (Moderate GRADE, Strong Recommendation) 14–17 Threshold for median IRP in the upright position is 12 mmHg for Medtronic systems and 15 mmHg for Laborie/Diversatek systems (Low GRADE, Strong Recommendation) 16–18 …”

Section: Standard Hrm Protocol and Thresholdsmentioning

confidence: 99%

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Yadlapati

Kahrilas

Fox

et al. 2020

Neurogastroenterology Motil

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Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high‐resolution manometry (HRM). Fifty‐two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two‐years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.

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Section: Standard Hrm Protocol and Thresholdsmentioning

confidence: 99%

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Yadlapati

Kahrilas

Fox

et al. 2020

Neurogastroenterology Motil

Self Cite

520

361

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“…Individual smooth muscle peristaltic sequences following 5 ml supine test swallows have been characterized on high‐resolution manometry (HRM) based on LES function, esophageal body contraction vigor, timing of peristalsis, and integrity of peristaltic contour. The integrated relaxation pressure (IRP) is used to determine adequacy of LES relaxation, and upper limits of normal are dependent on the HRM system utilized 3,5 . Contraction vigor is evaluated using distal contractile integral (DCI), which takes into account the amplitude, length, and duration of the smooth muscle contraction segments in the esophageal body.…”

Section: Hrm Metrics and Diagnostic Criteriamentioning

confidence: 99%

Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility

Gyawali

Zerbib

Bhatia

et al. 2021

Neurogastroenterology Motil

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Esophageal hypomotility disorders manifest with abnormal esophageal body contraction vigor, breaks in peristaltic integrity, or failure of peristalsis in the context of normal lower esophageal sphincter relaxation on esophageal high‐resolution manometry (HRM). The Chicago Classification version 4.0 recognizes two hypomotility disorders, ineffective esophageal motility (IEM) and absent contractility, while fragmented peristalsis has been incorporated into the IEM definition. Updated criteria for ineffective swallows consist of weak esophageal body contraction vigor measured using distal contractile integral (DCI, 100–450 mmHg·cm·s), transition zone defects >5 cm measured using a 20 mmHg isobaric contour, or failure of peristalsis (DCI < 100 mmHg·cm·s). More than 70% ineffective swallows and/or ≥50% failed swallows are required for a conclusive diagnosis of IEM. When the diagnosis is inconclusive (50%–70% ineffective swallows), supplementary evidence from multiple rapid swallows (absence of contraction reserve), barium radiography (abnormal bolus clearance), or HRM with impedance (abnormal bolus clearance) could support a diagnosis of IEM. Absent contractility requires 100% failed peristalsis, consistent with previous versions of the classification. Consideration needs to be given for the possibility of achalasia in absent contractility with dysphagia despite normal IRP, and alternate complementary tests (including timed upright barium esophagram and functional lumen imaging probe) are recommended to confirm or refute the presence of achalasia. Future research to quantify esophageal bolus retention on stationary HRM with impedance and to understand contraction vigor thresholds that predict bolus clearance will provide further refinement to diagnostic criteria for esophageal hypomotility disorders in future iterations of the Chicago Classification.

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“…The elevated integrated residual pressure (IRP) differentiates the case from absent contractility positive serologic test for Chagas' disease in patients without esophageal symptoms to find a large spectrum of motility alterations [22]. Whether this represents early motility changes prior to complete aperistalsis or just occasional findings commonly found in asymptomatic individuals [23] is not known.…”

Section: Achalasiamentioning

confidence: 99%

Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0)

et al. 2021

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The Chicago Classification is the most used classification for primary esophageal motility disorders (PEMD). This classification was recently updated to the 4.0 version. This opinion piece focuses on the possible implications for the treatment of PMED determined by the new classification. Chicago Classification 4.0 included two new concepts for the diagnosis of achalasia: (1) type III achalasia diagnosis demands 100% absent peristalsis defined as either failed peristalsis or spasm; (2) ''inconclusive diagnosis of achalasia'' was added as a possibility. Both may decrease unnecessary treatment. Esophagogastric junction outflow obstruction, distal esophageal spasm, and hypercontractile esophagus were only considered clinically significant when correlated to supportive testing and relevant clinical symptoms and in the absence of gastroesophageal reflux disease. This may decrease the surge of treatment, especially peroral endoscopic myotomy, based solely on manometric diagnosis.

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High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals

Cited by 26 publications

References 15 publications

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility

Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0)

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High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals

Cited by 26 publications

References 15 publications

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©

Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility

Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0)

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Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©