Additional Diagnostic Yield of the Rapid Drink Challenge in Chicago Classification Version 4.0 Compared With Version...

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Testing

Background:

• Chicago classification version 4.0 refines the diagnosis of esophageal motility disorders.
• Provocative tests like the rapid drink challenge are integral to updated diagnostic criteria.
• Functional luminal imaging probes aid in assessing esophageal function.

Purpose of the Study:

• To investigate the diagnostic utility of the rapid drink challenge within the Chicago classification 4.0 framework.
• To determine the cutoff value for the rapid drink challenge using a functional luminal imaging probe.
• To evaluate the impact of Chicago classification 4.0 on diagnoses made with the rapid drink challenge.

Main Methods:

• Esophageal manometry with a rapid drink challenge was performed on 570 patients.
• Diagnostic outcomes were analyzed according to Chicago classification 4.0 criteria.
• Functional luminal imaging probe data was used to establish cutoff values.

Main Results:

• The rapid drink challenge failed in 17.9% of patients.
• Chicago classification 4.0 led to diagnostic reclassifications in 55.0% of patients previously diagnosed with esophagogastric junction outflow obstruction.
• The diagnostic cutoff for rapid drink challenge-integrated relaxation pressure was determined to be 19 mmHg.

Conclusions:

• Chicago classification 4.0 slightly increased the diagnostic yield of the rapid drink challenge.
• The rapid drink challenge exhibits a high failure rate, questioning its routine application.
• An individualized approach to esophageal manometry is advised due to the rapid drink challenge's limitations.