Chicago Classification Version 4.0 and Its Impact on Current Clinical Practice

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Standards

Background:

• High-resolution manometry (HRM) is a key tool for diagnosing esophageal motility disorders.
• The Chicago Classification provides standardized metrics and definitions for these disorders.
• Previous versions have guided clinical practice and research in esophageal motility.

Purpose of the Study:

• To introduce the latest updates in the Chicago Classification (version 4.0) for esophageal motility disorders.
• To detail revisions in diagnostic criteria and the integration of new testing modalities.
• To provide updated guidance for clinicians managing patients with esophageal motility dysfunction.

Main Methods:

• The Chicago Classification version 4.0 was developed by a multidisciplinary international working group.
• It involved expanding the normal HRM database and incorporating ancillary function tests.
• Diagnostic criteria for specific disorders were refined based on expert consensus and new data.

Main Results:

• The normal database for HRM was significantly expanded (75 to 469 healthy volunteers).
• Ancillary tests like timed barium esophagram and impedance are recommended for inconclusive HRM findings.
• Refined criteria for esophagogastric junction outflow obstruction (EGJOO) and ineffective esophageal motility (IEM) were established.
• Mechanical obstruction must be excluded for diagnoses like distal esophageal spasm.

Conclusions:

• Chicago Classification 4.0 offers refined diagnostic criteria for esophageal motility disorders.
• The integration of ancillary tests improves diagnostic accuracy, particularly for EGJOO and IEM.
• Caution is advised regarding irreversible treatments for EGJOO and hypercontractile esophagus due to uncertain natural history.