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Related Concept Videos

Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
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Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy01:26

Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy

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This lesson explores three gastrointestinal imaging techniques: radionuclide testing, colonic transit studies, and virtual colonoscopy.
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
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Esophageal Varices-II: Clinical Features and Management01:28

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Endoscopic Procedures I: Esophagogastroduodenoscopy01:29

Endoscopic Procedures I: Esophagogastroduodenoscopy

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An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
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Endoscopic Studies I: Bronchoscopy and Thoracoscopy01:30

Endoscopic Studies I: Bronchoscopy and Thoracoscopy

276
Endoscopy is a non-surgical medical technique used to examine a person's internal organs and vessels. This lesson will focus on two types of endoscopic studies: bronchoscopy and thoracoscopy.
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
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Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

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Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
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Related Experiment Video

Updated: Sep 16, 2025

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
06:46

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Real-world Application of the Chicago Classification Version 4.0 for Esophageal Manometry: Asian Multicenter Study.

Soo In Choi1, Jong Wook Kim2, Kee Wook Jung3

  • 1National Medical Center, Seoul, Korea.

Journal of Neurogastroenterology and Motility
|July 8, 2025
PubMed
Summary

The Chicago classification version 4.0 (CC v4.0) shows varied application in Asian countries for esophageal motility disorders. Standardization is needed to improve diagnostic reliability and clinical practice.

Keywords:
Esophageal motility disordersManometryPractice patterns, physicians’Surveys and questionnaires

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Diagnostic Standards

Background:

  • The Chicago classification version 4.0 (CC v4.0) offers a standardized high-resolution manometry protocol for diagnosing esophageal motility disorders.
  • Real-world application of CC v4.0 in Asian countries requires investigation.

Purpose of the Study:

  • To assess the current application and compliance with the Chicago classification version 4.0 (CC v4.0) protocol in Asian countries.
  • To identify variations in diagnostic practices for esophageal motility disorders.

Main Methods:

  • Multi-institutional surveys were conducted using Google Survey from March to June 2023.
  • Questionnaires were distributed to members of the Asian Neurogastroenterology and Motility Association, assessing CC v4.0 protocol adherence and diagnostic methods.

Main Results:

  • Responses were received from 33 centers across 9 Asian countries.
  • Significant heterogeneity was observed in protocol adherence, including medication use (anticholinergics, narcotics), adaptation periods, breath counts, and swallowing intervals.
  • Variations in provocation test application (multiple rapid swallows, rapid drink challenge) and availability of complementary diagnostics (timed barium esophagography, functional lumen imaging probe) were noted.

Conclusions:

  • The study revealed considerable heterogeneity in the application of the Chicago classification version 4.0 (CC v4.0) protocol among Asian centers.
  • Standardization efforts are crucial to enhance inter-center reliability and reduce diagnostic ambiguity in esophageal motility disorder diagnosis.