The Chicago classification of motility disorders: an update

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Criteria

Background:

• High-resolution manometry (HRM) is crucial for diagnosing esophageal motility disorders.
• The Chicago Classification provides standardized criteria for interpreting HRM findings.
• Accurate classification is essential for appropriate patient management.

Purpose of the Study:

• To outline the diagnostic framework of the Chicago Classification for esophageal motility disorders.
• To detail the criteria for classifying esophago-gastric junction (EGJ) outflow obstruction and major/minor motility disorders.

Main Methods:

• Utilizes high-resolution manometry (HRM) with a standard protocol of 10 supine swallows.
• Defines disorders based on integrated relaxation pressure (IRP) at the EGJ and esophageal peristaltic patterns.
• Categorizes disorders into EGJ outflow obstruction, major, and minor motility disorders.

Main Results:

• Esophago-gastric junction (EGJ) outflow obstruction is defined by elevated median IRP.
• Major disorders include achalasia subtypes, EGJ outflow obstruction, aperistalsis, distal esophageal spasm, and hypercontractile esophagus.
• Minor disorders are limited to ineffective esophageal motility and fragmented peristalsis.

Conclusions:

• The Chicago Classification provides a robust system for diagnosing esophageal motility disorders via HRM.
• The latest version simplifies the classification by focusing on specific major and minor patterns.
• Standardized interpretation ensures consistent diagnosis and guides therapeutic decisions.