Citations 2
Chicago Classification update (version 4.0): Technical review on diagnostic criteria for achalasia
Khan, Anzalee , Yadlapati, Rena , Gonlachanvit, Sutep , Katzka, David A. , Vaezi, Michael F. , Vela, Marcelo F. , Pandolfino, John E. , Khan, Abraham , Vela, Marcelo, Park, Moo In
Neurogastroenterology & Motility | July 1, 2021 | Volume: 33 | Issue: 7 | Pages: No page available
Abstract The recommended diagnostic criteria for achalasia have been recently updated by Chicago Classification version 4.0 (CCv4.0), the widely accepted classification scheme for esophageal motility disorders using metrics from high‐resolution manometry (HRM). CCv4.0 continued upon prior versions by subtyping achalasia into type I, type II, and type III on HRM. The achalasia subgroup of the CCv4.0 Working Group developed both conclusive and inconclusive statements for the HRM diagnoses of achalasia subtypes. Conclusive achalasia on HRM is defined as an abnormal median integrated relaxation pressure (IRP) in the primary position of wet swallows along with 100% failed peristalsis, with type I achalasia having 100% failed peristalsis without panesophageal pressurization (PEP), type II achalasia with PEP in at least 20% of swallows, and type III achalasia having at least 20% of swallows premature with no appreciable peristalsis. An inconclusive HRM diagnosis of achalasia can arise when there is an integrated relaxation pressure (IRP) that is borderline or at the upper limit of normal in at least one position, there is an abnormal IRP in both positions but evidence of peristalsis with PEP or premature swallows, or there is peristalsis in the secondary position after apparent achalasia in the primary position. In patients with dysphagia and an inconclusive HRM diagnosis of achalasia, supportive testing beyond HRM such as a timed barium esophagram (TBE) for functional lumen imaging probe (FLIP) is recommended. The review recommends a diagnostic algorithm for achalasia, discusses therapeutic options for the disease, and outlines future needs on this topic.
Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0 ©
Yadlapati, Rena , Fox, Mark , Bredenoord, Albert J. , Gyawali, C. Prakash , Roman, Sabine , Babaei, Arash , Mittal, Ravinder K. , Rommel, Nathalie , Savarino, Edoardo , Smout, A. J. P. M. , Vaezi, Michael F. , Akiyama, Junichi, Bhatia, Shobna , Carlson, Dustin A. , Chen, Joan W. , Cisternas, Daniel , Cock, Charles , Defilippi, Claudia, Gonlachanvit, Sutep , Hebbard, Geoffrey , Jung, Kee Wook , Katz, Philip O. , Katzka, David A. , Khan, Anzalee , Kohn, Geoffrey P. , Lazarescu, Adriana , Lengliner, Johannes, Omari, Taher , Pohl, Daniel , Richter, Joel E. , Serra, Jordi , Sweis, Rami , Tack, Jan , Tatum, Roger P. , Vela, Marcelo F. , Wu, Justin C. Y. , Xiao, Yinglian , Pandolfino, John E. , Fox, Mark R , Gyawali, C P , Roman, S , Babaei, Arash , Mittal, Ravinder K , Sifrim, Daniel , Smout, André , Zerbib, Frank , Bor, Serhat , Carlson, Dustin A , Cisternas, Daniel , Cock, Charles , de Bortoli, Nicola , Fass, Ronnie , Ghoshal, Uday C , Jung, Kee Wook , Khan, Abraham , Omari, Taher , Park, Moo In , Penagini, Roberto , Serra, Jordi , Tack, Jan , Savarino, Edoardo , Kahrilas, Peter J. , Bor, Serhat , Coss‐Adame, Enrique , Bortoli, Nicola de , Fass, Ronnie , Ghoshal, Uday C. , Hani, Albis Cecilia , Mittal, Sumeet K. , Penagini, Roberto , Tutuian, Radu I. , Wong, Reuben K.
Neurogastroenterology & Motility | December 29, 2020 | Volume: 33 | Issue: 1 | Pages: No page available
Abstract Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal 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 diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. 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 patterns of disorders of peristalsis and obstruction at the EGJ.