Browsing by Author "Pohl, Daniel"

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    Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility
    (2021) Gyawali, C. Prakash; Zerbib, Frank; Bhatia, Shobna; Cisternas, Daniel; Coss-Adame, Enrique; Lazarescu, Adriana; Pohl, Daniel; Yadlapati, Rena; Penagini, Roberto; Pandolfino, John
    Esophageal hypomotility disorders manifest with abnormal esophageal body contraction vigor, breaks in peristaltic integrity, or failure of peristalsis in the context of normal lower esophageal sphincter relaxation on esophageal high-resolution manometry (HRM). The Chicago Classification version 4.0 recognizes two hypomotility disorders, ineffective esophageal motility (IEM) and absent contractility, while fragmented peristalsis has been incorporated into the IEM definition. Updated criteria for ineffective swallows consist of weak esophageal body contraction vigor measured using distal contractile integral (DCI, 100–450 mmHg·cm·s), transition zone defects >5 cm measured using a 20 mmHg isobaric contour, or failure of peristalsis (DCI < 100 mmHg·cm·s). More than 70% ineffective swallows and/or ≥50% failed swallows are required for a conclusive diagnosis of IEM. When the diagnosis is inconclusive (50%–70% ineffective swallows), supplementary evidence from multiple rapid swallows (absence of contraction reserve), barium radiography (abnormal bolus clearance), or HRM with impedance (abnormal bolus clearance) could support a diagnosis of IEM. Absent contractility requires 100% failed peristalsis, consistent with previous versions of the classification. Consideration needs to be given for the possibility of achalasia in absent contractility with dysphagia despite normal IRP, and alternate complementary tests (including timed upright barium esophagram and functional lumen imaging probe) are recommended to confirm or refute the presence of achalasia. Future research to quantify esophageal bolus retention on stationary HRM with impedance and to understand contraction vigor thresholds that predict bolus clearance will provide further refinement to diagnostic criteria for esophageal hypomotility disorders in future iterations of the Chicago Classification.
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    Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0
    (2021) Yadlapati, Rena; Kahrilas, Peter J.; Fox, Mark R.; Bredenoord, Albert J.; Gyawali, C. Prakash; Roman, Sabine; Babaei, Arash; Mittal, Ravinder K.; Rommel, Nathalie; Savarino, Edoardo; Sifrim, Daniel; Smout, André; Vaezi, Michael F.; Zerbib, Frank; Akiyama, Junichi; Bhatia, Shobna; Bor, Serhat; Carlson, Dustin A.; Chen, Joan W.; Cisternas, Daniel; Cock, Charles; Coss-Adame, Enrique; Bortoli, Nicola de; Defilippi, Claudia; Fass, Ronnie; Ghoshal, Uday C.; Gonlachanvit, Sutep; Hani, Albis; Hebbard, Geoffrey S.; Jung, Kee Wook; Katz, Philip; Katzka, David A.; Khan, Abraham; Kohn, Geoffrey Paul; Lazarescu, Adriana; Lengliner, Johannes; Mittal, Sumeet K.; Omari, Taher; Park, Moo I.; Penagini, Roberto; Pohl, Daniel; Richter, Joel E.; Serra, Jordi; Sweis, Rami; Tack, Jan; Tatum, Roger P.; Tutuian, Radu; Vela, Marcelo F.; Wong, Reuben K.; Wu, Justin C.; Xiao, Yinglian; Pandolfino, John E.
    Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esopha-geal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diag-nostic criteria for ineffective esophageal motility and description of baseline EGJ met-rics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for pat-terns of disorders of peristalsis and obstruction at the EGJ

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