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Are the Chicago 3.0 manometric diagnostics consistent with Chicago 4.0?

Angélica Tobón¹, Albis C Hani², Cristiam D Pulgarin¹

¹Gastroenterology and Endoscopy Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.

Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus

|December 20, 2023

Summary

The Chicago 4.0 protocol shows high concordance with the previous Chicago 3.0 for high-resolution manometry (HRM) interpretation. While most diagnoses remain consistent, CCv4.0 improves reclassification for ineffective esophageal motility (IEM).

Keywords:

Chicago 3.0 Chicago 4.0 concordance dysphagia high-resolution manometry

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Area of Science:

Gastroenterology
Diagnostic Medicine
Swallowing Disorders

Background:

High-resolution manometry (HRM) is crucial for diagnosing esophageal motility disorders.
The Chicago Classification (CC) provides a standardized framework for HRM interpretation.
CCv4.0 introduced new maneuvers, necessitating evaluation of its concordance with CCv3.0.

Purpose of the Study:

To assess the concordance between Chicago 3.0 (CCv3.0) and Chicago 4.0 (CCv4.0) protocols in HRM interpretation.
To evaluate the diagnostic value of new swallowing maneuvers in CCv4.0.
To determine the agreement in Integrated Relaxation Pressure (IRP) measurements across different positions and swallow types.

Main Methods:

Diagnostic accuracy study comparing CCv3.0 and CCv4.0 in 132 patients undergoing HRM.
Concordance assessed using Kappa test, Bland-Altman plots, and Lin's concordance correlation coefficient (CCC).
IRP agreement evaluated between supine/seated positions and with solid swallows.

Main Results:

Substantial agreement between CCv3.0 and CCv4.0 (Kappa 0.77, 87.9% total agreement).
Diagnostic reclassification occurred in 12.1% of patients, notably from IEM (CCv3.0) to normal motility (CCv4.0).
High agreement for IRP measurements (CCC 0.92 supine/seated, CCC 0.96 with solid swallows).

Conclusions:

CCv4.0 demonstrates high concordance with CCv3.0 for HRM interpretation.
CCv4.0 offers improved diagnostic reclassification, particularly for ineffective esophageal motility.
The updated protocol maintains reliable IRP measurements across different conditions.