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Ineffective esophageal motility in Chicago Classification version 4.0 better predicts abnormal acid exposure

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Abstract

Background

The updated Chicago Classification version 4.0 (CCv4.0) establishes a more stringent criteria to diagnose ineffective esophageal motility (IEM). This study aims to investigate the clinical significance of IEM in CCv4.0 in the context of gastroesophageal reflux disease (GERD).

Methods

A retrospective study was conducted among suspected GERD patients who had heartburn and/or regurgitation as their chief complaints and completed esophageal function tests in our center from 2017 to 2019. Patients were further grouped as “CCv3.0 IEM” and normal motility according to Chicago Classification version 3.0 (CCv3.0), and as “CCv4.0 IEM” and normal motility according to CCv4.0. The clinical characteristics, high-resolution manometry, esophageal reflux monitoring, and proton pump inhibitor (PPI) efficacy were compared between different groups. Multivariate analyses were performed to identify esophageal motility parameters associated with reflux burden and symptom outcome.

Results

Of 172 subjects included, 93 patients were identified as CCv3.0 IEM, 69 as CCv4.0 IEM. IEM in either version was concomitant with elevated acid burden and impaired esophageal clearance as compared to normal motility in corresponding diagnostic criteria, while the only presence of IEM in CCv4.0 was predictive to abnormal acid exposure (AET > 6%: OR = 2.66, 95% CI [1.27–5.56], p < 0.01). The presence of “CCv3.0 IEM” and low EGJ-CI (EGJ-CI < 39.1 mmHg·cm) had no added value in predicting increased reflux burden. No interaction effect was found between the presence of IEM and a weakened EGJ. None of the manometric variables was capable of predicting PPI response.

Conclusions

Stringent criteria of IEM in CCv4.0 can better predict abnormal acid exposure as compared to CCv3.0.

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Acknowledgements

The study was supported by grants from the National Natural Science Foundation of China (81970479) and Medical Scientific Research Foundation of Guangdong Province of China (A2019510). Specific thanks to Bin Li, medical statistician from Clinical Trials Unit, First Affiliated Hospital of Sun Yat-sen University, for providing professional statistical suggestions to this work.

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Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China

    Qian-jun Zhuang, Nian-di Tan, Meng-yu Zhang, Song-feng Chen, Yu Luo & Ying-lian Xiao

Authors
  1. Qian-jun Zhuang
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  2. Nian-di Tan
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  3. Meng-yu Zhang
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  4. Song-feng Chen
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  5. Yu Luo
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  6. Ying-lian Xiao
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Contributions

QJZ and NDT: study concept and design; acquisition of data; analysis and interpretation of data; drafting and finalizing the manuscript. MYZ, SFC, and YL: acquisition of data; analysis and interpretation of data, reviewing and editing the manuscript. YLX: study concept and design; finalizing the manuscript and guarantee of the study.

Corresponding author

Correspondence to Ying-lian Xiao.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

 Conflict of interest

All authors declared no conflict of interest.

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Informed consent or substitute for it was obtained from all patients for being included in the study.

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Zhuang, Qj., Tan, Nd., Zhang, My. et al. Ineffective esophageal motility in Chicago Classification version 4.0 better predicts abnormal acid exposure. Esophagus 19, 197–203 (2022). https://doi.org/10.1007/s10388-021-00867-5

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  • DOI: https://doi.org/10.1007/s10388-021-00867-5

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