Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility

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dc.contributor.authorGyawali, C. Prakash
dc.contributor.authorZerbib, Frank
dc.contributor.authorBhatia, Shobna
dc.contributor.authorCisternas, Daniel
dc.contributor.authorCoss-Adame, Enrique
dc.contributor.authorLazarescu, Adriana
dc.contributor.authorPohl, Daniel
dc.contributor.authorYadlapati, Rena
dc.contributor.authorPenagini, Roberto
dc.contributor.authorPandolfino, John
dc.date.accessioned2022-05-09T20:17:01Z
dc.date.available2022-05-09T20:17:01Z
dc.date.issued2021
dc.description.abstractEsophageal 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.es
dc.description.versionVersión Publicadaes
dc.identifier.citationGyawali CP, Zerbib F, Bhatia S, Cisternas D, Coss-Adame E, Lazarescu A, Pohl D, Yadlapati R, Penagini R, Pandolfino J. Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility. Neurogastroenterol Motil. 2021 Aug;33(8):e14134. doi: 10.1111/nmo.14134. Epub 2021 Mar 26. PMID: 33768698.es
dc.identifier.urihttps://doi.org/10.1111/nmo.14134es
dc.identifier.urihttp://hdl.handle.net/11447/6071
dc.language.isoenes
dc.subjectAbsent contractilityes
dc.subjectHigh-resolution manometryes
dc.subjectIneffective esophageal motilityes
dc.titleChicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractilityes
dc.typeArticlees
dcterms.sourceNeurogastroenterology & Motilityes

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