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High resolution esophageal manometry--the switch from "intuitive" visual interpretation to Chicago classification.

M Srinivas1, T A Balakumaran, S Palaniappan

  • 1Department of Gastroenterology, Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India, drsrinivasm@hotmail.com.

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Summary

The Chicago classification provides objective measurements for high-resolution esophageal manometry (HREM), improving diagnosis of esophageal motor disorders compared to visual interpretation alone.

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Diagnostic Imaging

Background:

  • High-resolution esophageal manometry (HREM) traditionally relies on subjective visual interpretation of color plots.
  • The Chicago classification introduced objective metrics for categorizing HREM findings.
  • Previous diagnostic approaches lacked standardization, potentially leading to inter-observer variability.

Purpose of the Study:

  • To compare the diagnostic concordance between visual interpretation and the Chicago classification for HREM.
  • To evaluate the ability of the Chicago classification to identify specific esophageal motor disorders.
  • To assess the utility of objective measurements in HREM interpretation.

Main Methods:

  • 77 consecutive HREM tracings were re-analyzed using Chicago classification criteria.
  • Software Trace 1.2v was employed for objective re-analysis.
  • Kappa agreement rate was calculated to quantify concordance between visual and Chicago classification interpretations.

Main Results:

  • 100% agreement (Kappa 1) was observed for achalasia and ineffective esophageal motility.
  • Chicago classification reclassified visually diagnosed normal motility, nutcracker esophagus, and nonspecific motility disorders.
  • New phenotypes, such as esophagogastric junction (EGJ) outflow obstruction, were identified by the Chicago classification.

Conclusions:

  • The Chicago classification offers a more objective and comprehensive approach to HREM interpretation.
  • It enhances the diagnosis of esophageal motor disorders, identifying phenotypes missed by visual assessment.
  • Objective classification improves diagnostic accuracy and standardization in HREM studies.