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Chicago Classification

The document outlines the Chicago Classification version 4.0 for evaluating esophageal manometry studies, focusing on disorders of esophagogastric junction (EGJ) outflow obstruction. It details the testing protocols, additional maneuvers for assessment, and diagnostic criteria for conditions such as achalasia and EGJ outlet obstruction. The findings from manometry need to be corroborated with patient symptoms and other supportive tests for accurate diagnosis.

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5 views2 pages

Chicago Classification

The document outlines the Chicago Classification version 4.0 for evaluating esophageal manometry studies, focusing on disorders of esophagogastric junction (EGJ) outflow obstruction. It details the testing protocols, additional maneuvers for assessment, and diagnostic criteria for conditions such as achalasia and EGJ outlet obstruction. The findings from manometry need to be corroborated with patient symptoms and other supportive tests for accurate diagnosis.

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drrefaee85
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© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Chicago Classification for the interpretation of

esophageal manometry: Evaluating for


disorders of EGJ outflow obstruction

This flow diagram represents a conceptual model of the process


for evaluating esophageal manometry studies using the
Chicago Classification version 4.0 diagnosis scheme. Esophageal
motility testing protocols may be modified based on the
patient's symptoms, suspected diagnosis, and ability to tolerate
the study. In addition, esophageal manometry testing protocols
may vary by center.

EGJ: esophagogastric junction; IRP: integrated relaxation


pressure; LES lower esophageal sphincter; PEP: panesophageal
pressurization.
* For further assessment of EGJ obstruction, additional
maneuvers may include rapid drink challenge, liquid swallows in
a secondary position (eg, upright), and/or multiple rapid
sequence swallows. These maneuvers may be performed if
abnormal IRP is suspected or as part of a center's protocol.
¶ The diagnosis of achalasia is based on clinical, endoscopic,
radiographic and manometric findings. Patients with achalasia
typically have an elevated median IRP based on 10 liquid
swallows. When additional maneuvers (eg, rapid drink
challenge) are performed in patients with achalasia, the IRP of
the LES is similarly elevated. However, a manometric pattern
consisting of absent peristalsis and elevated IRP based on an
additional maneuver only is regarded as inconclusive for type I
or II achalasia. In such cases, other testing such as timed
barium esophagram or functional luminal probe imaging may
help to establish that LES relaxation is impaired.
Δ Patients with EGJ outlet obstruction and presence of peristaltic
swallows fulfill criteria for EGJ outlet obstruction. However, such
patients may also have features suggestive of achalasia or other
patterns of abnormal peristalsis defined by criteria for disorders
of peristalsis: EGJ outlet obstruction with spastic features, EGJ
outlet obstruction with hypercontractile esophagus, EGJ outlet
obstruction with ineffective motility, or EGJ outlet obstruction
with no evidence of disordered peristalsis.
◊ Manometry findings suggest a likely diagnosis, but it needs to
be confirmed by symptoms and supportive testing.

From: Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders
on high-resolution manometry: Chicago classification version 4.0 ©.
Neurogastroenterol Motil 2021; 33(1):e14058.
[Link] Copyright © 2020
John Wiley & Sons Ltd. Reproduced with permission of John Wiley & Sons
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Graphic 86118 Version 4.0

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