The Chicago Classification of Motility Disorders

Roman, Sabine; Gyawali, C. Prakash; Xiao, Yinglian; Pandolfino, John E.; Kahrilas, Peter J.

doi:10.1016/j.giec.2014.07.001

Cited by 53 publications

(50 citation statements)

References 32 publications

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“…According to the HRM study, the median (interquartile) basal lower esophageal sphincter pressure, DCI, and rate of successful primary peristalsis were 7.7 (3.6-27) mm Hg, 1,237.1 (349.1-6,158.1) mm Hg-s-cm, and 30.0% (10-100), respectively. Based on the Chicago classification version 3 [17], 6 patients were diagnosed with ineffective esophageal motility.…”

Section: Resultsmentioning

confidence: 99%

The Effects of Switching to Vonoprazan, a Novel Potassium-Competitive Acid Blocker, on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors

et al. 2017

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Background/Aim: The effects of vonoprazan and proton pump inhibitors (PPIs) in patients with reflux esophagitis (RE) have not yet been compared using multichannel intraluminal impedance-pH (MII-pH). Methods: A total of 8 patients with persistent gastric mucosal injury, despite completing an 8-week standard PPI therapy, were enrolled in the study. While they were on standard PPI therapy, the baseline values of reflux parameters, holding time ratio (HTR) of gastric pH >4, and esophageal pH <4 were obtained by using 24 h MII-pH monitoring. They were re-evaluated after discontinuation of the therapy and 4 weeks of subsequent treatment with vonoprazan 20 mg/day. Results: The patients were found to be CYP2C19 extensive metabolizers and negative for Helicobacter pylori infection. In 7 patients (87.5%), the mucosal lesions had healed completely after vonoprazan therapy. A significant increase in gastric pH >4 HTR was observed, from 26.5 to 78.0% (p = 0.029). A reduction in esophageal pH <4 HTR was also observed but it was not statistically significant. Furthermore, acid clearance time and the total number of reflux events, including acid and proximal reflux events, were significantly reduced. Conclusion: Vonoprazan may be a better therapy for the treatment of patients with PPI-refractory RE.

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Section: Resultsmentioning

confidence: 99%

The Effects of Switching to Vonoprazan, a Novel Potassium-Competitive Acid Blocker, on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors

et al. 2017

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“…Finally, since completion of this study an updated Chicago classification version 3 has been published. 26 One of the primary changes in this classification is the inclusion of small peristaltic breaks (i.e less than 5cm) as a normal manometric finding. In fact, this change is congruous with our findings as patients with small peristaltic breaks mirrored the demographics, presenting symptoms, and the natural history of those with normal esophageal manometry studies.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes of Patients With Normal or Minor Motor Function Abnormalities Detected by High-resolution Esophageal Manometry

Ravi

Friesen

Issaka

et al. 2015

Clinical Gastroenterology and Hepatology

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Background & Aims High-resolution manometry (HRM) expands recognition of minor esophageal motor abnormalities, but the clinical significance of these is unclear. We aimed to determine the outcomes of minor esophageal motor abnormalities. Methods We reviewed HRM tracings from individuals who underwent esophageal manometry at Northwestern Memorial Hospital from July 2004 through October 2005, using the Chicago classification (version 2.0). We identified 301 patients with normal findings or minor manometric abnormalities (weak peristalsis, hypertensive peristalsis, frequent failed peristalsis, or rapid contractions with normal latency). Ninety-eight patients participated in a phone survey in which they were asked questions from the impact dysphagia questionnaire (IDQ; mean follow-up period: 6 years 5 months). Results Of 301 the patients assessed, 166 had normal findings from HRM, 82 had weak peristalsis, 34 had hypertensive peristalsis, 17 had frequent failed peristalsis, and 2 had rapid contractions with normal latency. The primary indications for HRM of dysphagia (44%) and gastroesophageal reflux (63%) were unrelated to manometric findings. There were no endoscopic or video-fluoroscopic differences between patients with minor manometric abnormalities. Of 98 patients with follow up, findings from HRM were normal in 63, weak peristalsis was observed in 23, hypertensive peristalsis in 10, and frequent failed peristalsis in 2. No patients underwent surgical myotomy, pneumatic dilation, or botulinum toxin injection. Use of proton-pump inhibitors and rates of fundoplication were similar, regardless of manometric findings. Sixteen patients (16%) had significant dysphagia at follow up; hypertensive peristalsis was the most likely to be symptomatic. Conclusion Patients with normal and minor esophageal motor abnormalities report minimal symptoms and have few medical interventions related to esophageal dysfunction during long-term follow up. Identification of normal and minor motor function is therefore likely a good prognostic indicator.

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“…Oesophageal dysphagia might also arise from abnormalities in the oesophageal body and the LES, including primary or secondary motility disorders. 81 However, our knowledge of the relationship between abnormal motor function and oesophageal dysphagia symptoms is limited, as is our understanding of the intrinsic mechanisms and neurotransmitters involved in the control of oesophageal peristalsis and LES relaxation. 75,76,82 Research into these two aspects will be critical to understand the pathophysiology of symptoms of oesophageal dysphagia and develop effective pharmacologic treatments for patients.…”

Section: Complicationsmentioning

confidence: 99%

“…101,102 This classification has been defined as the Chicago Classification and has been periodically revised by the International GI Motility and Function Working Group. 81 Impaired LES relaxation and absent peristalsis in the oesophageal body are found in all types of achalasia; type I achalasia is characterized by low intra-oesophageal pressure as a consequence of oesophageal dilation; type II is defined as achalasia with compression and is characterized by pan-oesophageal pressurization >30 mmHg, minimal oesophageal dilation and good response to dilation or surgical treatment; 101 and type III achalasia (also known as achalasia with distal spasm or 'vigorous achalasia') is associated with high amplitude simultaneous contractions, functional obstruction of the distal oesophagus and poor response to all therapies.…”

Section: Mechanical Causesmentioning

confidence: 99%

Dysphagia: current reality and scope of the problem

Clavé

Shaker

2015

Nat Rev Gastroenterol Hepatol

377

220

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Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.

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The Chicago Classification of Motility Disorders

Cited by 53 publications

References 32 publications

The Effects of Switching to Vonoprazan, a Novel Potassium-Competitive Acid Blocker, on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors

The Effects of Switching to Vonoprazan, a Novel Potassium-Competitive Acid Blocker, on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors

Long-term Outcomes of Patients With Normal or Minor Motor Function Abnormalities Detected by High-resolution Esophageal Manometry

Dysphagia: current reality and scope of the problem

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