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Chicago Classification Version 4.0 Improves Stratification of Ineffective Esophageal Motility Patients into

Moshe Carmel1,2, Daniel L Cohen3, Basem Hijazi4

  • 1Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel. mocarmel@gmail.com.

Dysphagia
|November 7, 2023
PubMed

Insights

The updated Chicago Classification v4.0 for esophageal motility disorders restricts Ineffective Esophageal Motility (IEM) diagnoses. Patients with IEM under v4.0 show poorer esophageal function and higher acid exposure, indicating a more clinically relevant patient group.

Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Diagnostic Criteria

Background:

  • The Chicago Classification (CC) provides standardized criteria for esophageal motility disorders.
  • CC v4.0 introduced more restrictive criteria for Ineffective Esophageal Motility (IEM) compared to CC v3.0.
  • Understanding the impact of these updated criteria is crucial for accurate diagnosis and patient management.

Purpose of the Study:

  • To compare patients diagnosed with IEM under CC v3.0 who were reclassified as normal under CC v4.0 versus those who retained an IEM diagnosis.
  • To evaluate the clinical and manometric differences between these groups.
  • To assess the impact of the new CC v4.0 criteria on IEM diagnosis.

Main Methods:

  • Retrospective case-control study analyzing high-resolution manometry (HRM) data from 2020-2021.
  • Reanalyzed studies initially diagnosed with IEM under CC v3.0 using CC v4.0 criteria.
  • Compared demographics, clinical data, manometry, and pH-monitoring parameters between groups.

Main Results:

  • Out of 154 CC v3.0 IEM cases, 39 (25%) were reclassified as normal by CC v4.0.
  • The CC v4.0 normal group exhibited better recovered contractions and lower acid exposure time than the CC v4.0 IEM group.
  • CC v4.0 identified fewer patients with IEM, identifying a cohort with significantly worse esophageal function and higher acid burden.

Conclusions:

  • CC v4.0 criteria for IEM are more restrictive than CC v3.0.
  • The updated criteria successfully identify a subgroup of patients with IEM who exhibit more severe esophageal dysfunction and higher acid exposure.
  • CC v4.0 may refine IEM diagnosis to a more clinically significant population, warranting further investigation.

Keywords:
Chicago classificationEsophageal hypomotilityGastroesophageal refluxHigh-resolution manometryIneffective esophageal motility

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