Oesophageal overlap motility disorders: beyond Chicago classification V.4.0

Patients with oesophageal motility disorders may present with dysphagia, regurgitation or chest pain. High-resolution manometry (HRM) is the current gold-standard modality for the diagnosis of oesophageal motility disorders. The data from HRM are analysed and interpreted to form a diagnosis based on the Chicago classification. However, the Chicago classification is a work in progress, and a few cases can present with features beyond the scope of the current Chicago classification. We present two such cases with distinctive manometric features of an elevated distal contractile integral and increased integrated relaxation pressure but no intrabolus pressurisation or decreased distal latency. As such, they do not fit into any pattern described in the current Chicago classification V.4.0 and can be best described as overlap motility disorders or mixed motor disorders. Patients with such findings warrant further evaluation and long-term follow-up to understand if they evolve to fit into any disorder currently described in the Chicago classification.