Abstract
The Chicago Classification (CC), now in its fourth iteration [CC Version 4.0 (CC v4.0)], represents the quintessential interpretation and classification scheme for the evaluation of motor function and the diagnosis of motility disorders with esophageal high-resolution manometry (HRM). This current iteration was developed by a diverse international group of esophageal motility experts representing several international motility societies and with methodologic rigor. Relative to prior CC versions, several major, clinically significant modifications have been made, largely aimed at minimizing over-diagnosis of manometrically inconclusive conditions. Specifically, CC v4.0 stipulates an ideal standardized study protocol for consistency among centers, emphasizes the need for and utility of additional supporting data in instances of inconclusive diagnoses (both manometric, with provocative maneuvers, and non-manometric studies), the importance of clinically relevant symptoms with inconclusive diagnoses, the elimination of a distinction between major and minor motility disorders, and more stringent criteria for diagnoses of EGJOO, DES, hypercontractile esophagus, and IEM. Future iterations of the CC will be inspired by fresh data and investigations focusing on therapeutic outcomes to build upon these refinements.
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Abbreviations
- CC v4.0:
-
CC Version 4.0
- CC:
-
Chicago Classification
- CD:
-
Crural diaphragm
- CDP:
-
Contractile deceleration point
- DCI:
-
Distal contractile integral
- DES:
-
Distal esophageal spasm
- DL:
-
Distal latency
- EGJ:
-
Esophagogastric junction
- EGJ-CI:
-
EGJ contractile integral
- EGJOO:
-
EGJ outflow obstruction
- FLIP:
-
Functional lumen imaging probe
- GRADE:
-
Grading of Recommendations Assessment; Development; and Evaluation
- HRM:
-
High-resolution manometry
- IEM:
-
Ineffective esophageal motility
- IRP:
-
Integrated relaxation pressure
- LES:
-
Lower esophageal sphincter
- MRS:
-
Multiple rapid swallow
- OIED:
-
Opioid induced esophageal dysfunction
- PEP:
-
Panesophageal pressurization
- POEM:
-
Per-oral endoscopic myotomy
- RDC:
-
Rapid drink challenge
- RIP:
-
Respiratory inversion point
- TBE:
-
Timed barium esophagram
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Rena Yadlapati: Consultant through Institutional Agreement: Medtronic, Ironwood Pharmaceuticals, Diversatek; Research support: Ironwood Pharmaceuticals; Advisory Board: Phathom Pharmaceuticals; RJS Mediagnostix; Amit Patel: none; Peter J. Kahrilas: Consultant: Ironwood Pharmaceuticals, Reckitt Benckiser.
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Peter J. Kahrilas is supported by P01 DK092217 (John E. Pandolfino) from the US Public Health Service.
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RY, AP, PJK: Literature review, Drafting of manuscript, Critical revision of manuscript, Final approval of manuscript to be published.
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Yadlapati, R., Patel, A., Kahrilas, P.J. (2023). The Chicago Classification of Esophageal Motor Disorders. In: Nguyen, N.T., et al. The AFS Textbook of Foregut Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-19671-3_29
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