Clinical Characteristics of Patients With Ineffective Esophageal Motility by Chicago Classification Version 4.0...

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Criteria Evolution

Background:

• The Chicago classification (CC) is a standard for diagnosing esophageal motility disorders.
• Version 4.0 (CCv4.0) introduced stricter criteria for ineffective esophageal motility (IEM) compared to version 3.0 (CCv3.0).
• Understanding the clinical impact of these revised IEM criteria is crucial.

Purpose of the Study:

• To evaluate the implications of CCv4.0's stricter diagnostic criteria on IEM prevalence.
• To clinically characterize and compare patients reclassified as normal versus those retaining an IEM diagnosis under CCv4.0.
• To assess manometric and reflux parameters associated with IEM under the new criteria.

Main Methods:

• Analysis of high-resolution esophageal impedance manometries performed between 2014 and 2021.
• Categorization of patients into three groups: IEM by CCv3.0 (CC3), IEM by CCv4.0 only (CC4), and those no longer meeting IEM criteria under CCv4.0 (Normal).
• Comparison of demographics, manometric findings, reflux parameters (including Demeester score), and clinical outcomes across the three groups.

Main Results:

• Of 66 patients initially diagnosed with IEM by CCv3.0, 41 (62%) retained the diagnosis under CCv4.0 (CC4 group), while 25 (38%) were reclassified as Normal.
• The CC4 group exhibited significantly higher esophageal acid exposure (especially supine), lower peristaltic reserve, and higher Demeester scores compared to the Normal group.
• No significant difference in bolus clearance was observed between the CC4 and Normal groups.

Conclusions:

• CCv4.0's refined IEM criteria identify patients with a stronger association with pathologic reflux, particularly supine reflux, and inadequate peristaltic reserve.
• Bolus clearance impairment remains consistent in IEM patients regardless of the Chicago classification version used for diagnosis.
• Further research is needed to ascertain the clinical management implications of these updated diagnostic findings for IEM.