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

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Criteria Development

Background:

• Esophageal motility disorders require standardized diagnostic criteria.
• Previous versions of the Chicago Classification have limitations in diagnostic clarity.
• High-resolution manometry (HRM) is a key tool for assessing esophageal function.

Purpose of the Study:

• To introduce and detail the updates in the Chicago Classification v4.0 (CCv4.0).
• To establish more rigorous and standardized diagnostic criteria for esophageal motility disorders.
• To refine the assessment of esophagogastric junction (EGJ) outflow obstruction and ineffective esophageal motility.

Main Methods:

• Development of CCv4.0 involved 52 international experts over two years.
• Utilized formal, validated methodologies in seven working subgroups.
• Incorporated an expanded HRM protocol including supine/upright positions and provocative testing.

Main Results:

• CCv4.0 features a refined definition of esophagogastric junction outflow obstruction (EGJOO).
• Introduced more stringent criteria for ineffective esophageal motility and baseline EGJ metrics.
• Delineated motility disorder diagnoses as conclusive or inconclusive based on symptoms and provocative/supportive testing.

Conclusions:

• CCv4.0 aims to minimize ambiguity present in prior Chicago Classification iterations.
• Provides more standardized and rigorous criteria for esophageal peristalsis and EGJ obstruction.
• Enhances diagnostic accuracy and consistency for esophageal motility disorders.