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Choi SI. Exploration of Diagnostic Value of Chicago Classification Version 4.0: Focusing on Rapid Drink Challenge. J Neurogastroenterol Motil 2024; 30:381-382. [PMID: 39397614 PMCID: PMC11474563 DOI: 10.5056/jnm24121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 09/03/2024] [Indexed: 10/15/2024] Open
Affiliation(s)
- Soo In Choi
- Division of Gastroenterology, Department of Internal Medicine, National Medical Center, Seoul, Korea
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Kamboj AK, Katzka DA, Vela MF, Yadlapati R, Ravi K. A practical approach to ineffective esophageal motility. Neurogastroenterol Motil 2024; 36:e14839. [PMID: 38837280 PMCID: PMC11321916 DOI: 10.1111/nmo.14839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND PURPOSE Ineffective esophageal motility (IEM) is the most frequently diagnosed esophageal motility abnormality and characterized by diminished esophageal peristaltic vigor and frequent weak, absent, and/or fragmented peristalsis on high-resolution esophageal manometry. Despite its commonplace occurrence, this condition can often provoke uncertainty for both patients and clinicians. Although the diagnostic criteria used to define this condition has generally become more stringent over time, it is unclear whether the updated criteria result in a more precise clinical diagnosis. While IEM is often implicated with symptoms of dysphagia and gastroesophageal reflux disease, the strength of these associations remains unclear. In this review, we share a practical approach to IEM highlighting its definition and evolution over time, commonly associated clinical symptoms, and important management and treatment considerations. We also share the significance of this condition in patients undergoing evaluation for anti-reflux surgery and consideration for lung transplantation.
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Affiliation(s)
- Amrit K. Kamboj
- Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - David A. Katzka
- Department of Digestive and Liver Diseases, Columbia University, New York, NY
| | - Marcelo F. Vela
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ
| | - Rena Yadlapati
- Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA
| | - Karthik Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Low EXS, Wang YP, Ye YC, Liu PY, Sung KY, Lin HE, Lu CL. A Comparison between Chicago Classification Versions 3.0 and 4.0 and Their Impact on Manometric Diagnoses in Esophageal High-Resolution Manometry Cases. Diagnostics (Basel) 2024; 14:263. [PMID: 38337780 PMCID: PMC10854946 DOI: 10.3390/diagnostics14030263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
High-resolution manometry (HRM) facilitates the detailed evaluation of esophageal motility. In December 2020, Chicago classification (CC) version 4.0 introduced modifications to improve consistency and accuracy. We conducted this study to compare the differences in the interpretations of HRM examinations between CC 3.0 and 4.0. Consecutive HRM records at a Taiwan tertiary medical center, including wet swallows and MRS performed in both supine and sitting positions from October 2019 to May 2021, were retrospectively reviewed and analyzed using both CC versions 3.0 and 4.0. A total of 105 patients were enrolled, and 102 patients completed the exam, while three could not tolerate HRM sitting up. Refractory gastroesophageal reflux disease (GERD) symptoms (n = 65, 63.7%) and dysphagia (n = 37, 36.3%) were the main indications. A total of 18 patients (17.6%) were reclassified to new diagnoses using CC 4.0. Of the 11 patients initially diagnosed with absent contractility, 3 (27.3%) were reclassified as having Type 1 achalasia. Of the 18 patients initially diagnosed with IEM, 6 (33.3%) were reclassified as normal. The incidence of diagnosis changes was similar in both the dysphagia and refractory GERD symptoms groups (21.6% versus 15.3%, p = 0.43). The use of CC 4.0 led to changes in the diagnoses of esophageal motility disease, irrespective of examination indications. Early adoption improves the accuracy of diagnoses and affects patient management.
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Affiliation(s)
- En Xian Sarah Low
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore 609606, Singapore
| | - Yen-Po Wang
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei 11221, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
| | - Yong-Cheng Ye
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
| | - Pei-Yi Liu
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
| | - Kuan-Yi Sung
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Division of Gastroenterology, Department of Medicine, Fu Jen Catholic University Hospital, Taipei 24352, Taiwan
| | - Hung-En Lin
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Division of Gastroenterology, Department of Medicine, Taipei City Hospital Chongxing Branch, Taipei 10321, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.X.S.L.); (Y.-C.Y.); (P.-Y.L.); (K.-Y.S.); (H.-E.L.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei 11221, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
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