Chicago Classification Update (v4.0): Technical review on diagnostic criteria for hypercontractile esophagus

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Criteria Updates

Background:

• Hypercontractile esophagus (HE) is a heterogeneous esophageal motility disorder.
• Current diagnostic criteria (Chicago Classification v3.0) lack clinical relevance, posing management challenges.
• An update was needed to refine HE diagnosis.

Purpose of the Study:

• To update diagnostic criteria for clinically relevant hypercontractile esophagus (HE).
• To emphasize the integration of manometric findings with clinical symptoms for diagnosis.
• To align with the Chicago Classification version 4.0 (CCv4.0) focus on clinically relevant esophageal dysmotility.

Main Methods:

• Extensive literature review on HE by the CCv4.0 Working Group.
• Ranking of diagnostic statements using RAND UCLA Appropriateness methodology.
• Quality of evidence assessment using the GRADE framework.

Main Results:

• Recommended HE diagnosis requires both conclusive high-resolution manometry (HRM) and clinically relevant symptoms (dysphagia, non-cardiac chest pain).
• CCv4.0 emphasizes clinically relevant esophageal dysmotility.
• Subtypes like Jackhammer esophagus were recognized but not formally subdivided for clinical practice due to insufficient data.

Conclusions:

• The updated criteria integrate manometric and symptomatic data for a more clinically relevant HE diagnosis.
• This approach aims to improve the management of patients with HE.
• Further research is needed to support formal subdivision of HE subtypes in clinical practice.