Oesophageal overlap motility disorders: beyond Chicago classification V.4.0

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Modalities

Background:

• Esophageal motility disorders present with symptoms like dysphagia and chest pain.
• High-resolution manometry (HRM) is the gold standard for diagnosing these disorders.
• The Chicago classification guides HRM data interpretation but has limitations.

Purpose of the Study:

• To present two unique cases of esophageal motility disorders.
• To describe manometric features that fall outside the current Chicago classification.
• To discuss the implications for diagnosing and managing 'overlap' or 'mixed' motor disorders.

Main Methods:

• Utilized high-resolution manometry (HRM) for esophageal pressure measurement.
• Analyzed manometric data based on established parameters.
• Interpreted findings in the context of the Chicago classification (V.4.0).

Main Results:

• Two patients exhibited elevated distal contractile integral and increased integrated relaxation pressure.
• These findings did not align with any defined patterns in the Chicago classification V.4.0.
• The cases were characterized as potential overlap or mixed esophageal motor disorders.

Conclusions:

• Certain esophageal motility patterns may not fit current diagnostic criteria.
• These 'overlap' disorders require further investigation and long-term follow-up.
• Understanding these atypical presentations can refine diagnostic classifications.