The Chicago Classification of esophageal motility disorders, v3.0

• DOI: 10.1111/nmo.12477
• Publication Date: 2014-12-03T19:46:23Z
• Authors: P. J. Kahrilas; A. J. Bredenoord; M. Fox; C. P. Gyawali; S. Roman; A. J. P. M. Smout; J. E. Pandolfino
• Keywords: Esophageal Achalasia; 0301 basic medicine; 03 medical and health sciences; 0302 clinical medicine; Manometry; 13. Climate action; Image Interpretation, Computer-Assisted; Humans; Esophageal Motility Disorders; 7. Clean energy; Achalasia; Dysphagia; Esophageal motility disorders; High-resolution manometry; Ineffective esophageal motility; Esophageal Achalasia; Esophageal Motility Disorders; Humans; Manometry; Image Interpretation, Computer-Assisted; Endocrine and Autonomic Systems; Gastroenterology; Physiology; Medicine (all); 3. Good health

AbstractBackgroundThe Chicago Classification (CC) of esophageal motility disorders, utilizing an algorithmic scheme to analyze clinical high‐resolution manometry (HRM) studies, has gained acceptance worldwide.MethodsThis 2014 update, CC v3.0, developed by the International HRM Working Group, incorporated the extensive clinical experience and interval publications since the prior (2011) version.Key ResultsChicago Classification v3.0 utilizes a hierarchical approach, sequentially prioritizing: (i) disorders of esophagogastric junction (EGJ) outflow (achalasia subtypes I‐III and EGJ outflow obstruction), (ii) major disorders of peristalsis (absent contractility, distal esophageal spasm, hypercontractile esophagus), and (iii) minor disorders of peristalsis characterized by impaired bolus transit. EGJ morphology, characterized by the degree of overlap between the lower esophageal sphincter and the crural diaphragm and baseline EGJ contractility are also part of CC v3.0. Compared to the previous CC version, the key metrics of interpretation, the integrated relaxation pressure (IRP), the distal contractile integral (DCI), and the distal latency (DL) remain unchanged, albeit with much more emphasis on DCI for defining both hypo‐ and hypercontractility. New in CC v3.0 are: (i) the evaluation of the EGJ at rest defined in terms of morphology and contractility, (ii) ‘fragmented’ contractions (large breaks in the 20‐mmHg isobaric contour), (iii) ineffective esophageal motility (IEM), and (iv) several minor adjustments in nomenclature and defining criteria. Absent in CC v3.0 are contractile front velocity and small breaks in the 20‐mmHg isobaric contour as defining characteristics.Conclusions & InferencesChicago Classification v3.0 is an updated analysis scheme for clinical esophageal HRM recordings developed by the International HRM Working Group.