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Chicago classification version 4.0© technical review: Update on standard high-resolution manometry protocol for the
Mark R Fox1, Rami Sweis2, Rena Yadlapati3
1Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
Insights
The Chicago Classification v4.0 (CCv4.0) enhances esophageal motility disorder diagnosis using high-resolution manometry (HRM) with expanded testing protocols. This updated scheme aims for more precise diagnoses and standardized global procedures.
Area of Science:
- Gastroenterology
- Esophageal Physiology
- Diagnostic Technology
Background:
- The Chicago Classification (CC) provides a standardized framework for diagnosing esophageal motility disorders.
- Previous versions of CC had limitations leading to ambiguous or inconclusive high-resolution manometry (HRM) diagnoses.
- Advancements in HRM technology necessitate updated diagnostic criteria.
Purpose of the Study:
- To detail the updated Chicago Classification v4.0 (CCv4.0) for esophageal motility disorders.
- To describe the expanded HRM protocol, including provocative testing, for improved diagnostic accuracy.
- To establish a standardized global manometry protocol for consistency and research.
Main Methods:
- Incorporation of single wet swallows in supine and upright positions.
- Inclusion of provocative testing: multiple rapid swallows and rapid drink challenge.
- Utilization of solid bolus swallows, solid test meals, and pharmacologic provocation.
Main Results:
- CCv4.0 employs a more rigorous and expansive HRM protocol.
- Provocative tests enhance diagnostic sensitivity and specificity for esophageal motility disorders.
- The updated classification aims to minimize ambiguity and reduce inconclusive HRM diagnoses.
Conclusions:
- CCv4.0 provides a refined diagnostic scheme for esophageal motility disorders.
- The expanded protocol and provocative testing improve diagnostic yield and therapeutic guidance.
- Standardization of HRM protocols facilitates procedural consistency, diagnostic reliability, and collaborative research.
Abstract:
The Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). A key feature of CCv.4.0 is the more rigorous and expansive protocol that incorporates single wet swallows acquired in different positions (supine, upright) and provocative testing, including multiple rapid swallows and rapid drink challenge. Additionally, solid bolus swallows, solid test meal, and/or pharmacologic provocation can be used to identify clinically relevant motility disorders and other conditions (eg, rumination) that occur during and after meals. The acquisition and analysis for performing these tests and the evidence supporting their inclusion in the Chicago Classification protocol is detailed in this technical review. Provocative tests are designed to increase the diagnostic sensitivity and specificity of HRM studies for disorders of esophageal motility. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification, decrease the proportion of HRM studies that deliver inconclusive diagnoses and increase the number of patients with a clinically relevant diagnosis that can direct effective therapy. Another aim in establishing a standard manometry protocol for motility laboratories around the world is to facilitate procedural consistency, improve diagnostic reliability, and promote collaborative research.
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