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From Chicago classification v3.0 to v4.0: Diagnostic changes and clinical implications.

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Summary

The Chicago Classification (CC) for esophageal motility disorders has updated. Version 4.0 (CCv4.0) diagnoses ineffective esophageal motility (IEM) less frequently than version 3.0 (CCv3.0), potentially linking IEM to GERD.

Keywords:
Chicago classification v4.0dysphagiaesophageal motility disordershigh-resolution manometryineffective esophageal motilityquestionnaires

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Area of Science:

  • Gastroenterology
  • Digestive Physiology

Background:

  • The Chicago Classification (CC) is crucial for diagnosing esophageal motility disorders using high-resolution manometry (HRM).
  • The CC has undergone revisions, with the latest versions impacting diagnostic criteria.

Purpose of the Study:

  • To compare diagnostic frequencies of esophageal motility disorders between CC version 3.0 (CCv3.0) and version 4.0 (CCv4.0).
  • To assess the correlation between motility disorder diagnoses and symptom severity.

Main Methods:

  • Retrospective analysis of 130 patients undergoing esophageal HRM.
  • Application of both CCv3.0 and CCv4.0 to HRM studies.
  • Evaluation of symptom severity and quality of life using standardized questionnaires.

Main Results:

  • Motility disorder diagnoses remained consistent in 78% of patients between CCv3.0 and CCv4.0.
  • CCv4.0 diagnosed fewer cases of ineffective esophageal motility (IEM) compared to CCv3.0 (38% of CCv3.0 IEM cases were normal with CCv4.0).
  • Patients with esophago-gastric junction relaxation disorders reported higher dysphagia scores than those with IEM.

Conclusions:

  • While diagnoses are largely stable, CCv4.0 identifies IEM less frequently than CCv3.0.
  • Higher GERD-Q scores in IEM patients under CCv4.0 suggest this version may better identify IEM associated with GERD.