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What is new in Chicago Classification version 4.0?

Rena Yadlapati1, John E Pandolfino2, Mark R Fox3

  • 1Division of Gastroenterology, Center for Esophageal Diseases, University of California San Diego, La Jolla, CA, USA.

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|December 19, 2020
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Summary
This summary is machine-generated.

The updated Chicago Classification version 4.0 (CCv4.0) refines high-resolution manometry (HRM) diagnostics for esophageal motility disorders. It emphasizes symptom correlation and standardized protocols for accurate clinical diagnosis.

Keywords:
achalasiaesophageal motilityesophageal pressure topographygastroesophageal reflux diseaseper-oral endoscopic myotomy

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Diagnostic Criteria

Background:

  • High-resolution manometry (HRM) applications have grown since the 2015 Chicago Classification v3.0.
  • An International HRM Working Group of 52 experts updated the classification over two years.

Purpose of the Study:

  • To present the key modifications and advancements in the Chicago Classification version 4.0 (CCv4.0).
  • To provide updated diagnostic criteria for esophageal motility disorders using high-resolution manometry.

Main Methods:

  • Formal validation methodologies were employed by the international working group.
  • The update involved synthesizing expert consensus on manometric and non-manometric evaluations.
  • Standardized manometric protocols were refined, including positional and provocative testing.

Main Results:

  • CCv4.0 requires further evaluation for conclusive esophagogastric junction (EGJ) outflow obstruction (EGJOO) diagnosis.
  • EGJOO, distal esophageal spasm, and hypercontractile esophagus require obstructive symptoms (dysphagia/chest pain) for clinical relevance.
  • Ineffective esophageal motility definition is more stringent, including fragmented peristalsis.
  • CCv4.0 simplifies classification into EGJ outflow disorders and peristaltic disorders.

Conclusions:

  • CCv4.0 enhances the diagnostic accuracy of high-resolution manometry for esophageal motility disorders.
  • The updated classification integrates clinical symptoms with manometric findings for improved patient management.
  • CCv4.0 provides a more refined framework for diagnosing and classifying esophageal functional disorders.