Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©,Neurogastroenterology & Motility

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Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©
Neurogastroenterology & Motility ( IF 3.5 ) Pub Date : 2020-12-29 , DOI: 10.1111/nmo.14058
Rena Yadlapati ₁ , Peter J Kahrilas ₂ , Mark R Fox _{3,

4} , Albert J Bredenoord ₅ , C Prakash Gyawali ₆ , Sabine Roman _{7,

8} , Arash Babaei ₉ , Ravinder K Mittal _{1,

10} , Nathalie Rommel ₁₁ , Edoardo Savarino ₁₂ , Daniel Sifrim ₁₃ , André Smout ₅ , Michael F Vaezi ₁₄ , Frank Zerbib ₁₅ , Junichi Akiyama ₁₆ , Shobna Bhatia ₁₇ , Serhat Bor ₁₈ , Dustin A Carlson ₂ , Joan W Chen ₁₉ , Daniel Cisternas ₂₀ , Charles Cock ₂₁ , Enrique Coss-Adame ₂₂ , Nicola de Bortoli ₂₃ , Claudia Defilippi ₂₄ , Ronnie Fass ₂₅ , Uday C Ghoshal ₂₆ , Sutep Gonlachanvit ₂₇ , Albis Hani ₂₈ , Geoffrey S Hebbard ₂₉ , Kee Wook Jung ₃₀ , Philip Katz ₃₁ , David A Katzka ₃₂ , Abraham Khan ₃₃ , Geoffrey Paul Kohn ₃₄ , Adriana Lazarescu ₃₅ , Johannes Lengliner ₃₆ , Sumeet K Mittal ₃₇ , Taher Omari ₃₈ , Moo In Park ₃₉ , Roberto Penagini ₄₀ , Daniel Pohl ₄₁ , Joel E Richter ₄₂ , Jordi Serra ₄₃ , Rami Sweis ₄₄ , Jan Tack ₄₅ , Roger P Tatum ₄₆ , Radu Tutuian _{47,

48} , Marcelo F Vela ₄₉ , Reuben K Wong ₅₀ , Justin C Wu ₅₁ , Yinglian Xiao ₅₂ , John E Pandolfino ₂

Affiliation

Center for Esophageal Diseases, Division of Gastroenterology & Hepatology, University of California San Diego, La Jolla, CA, USA.
Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland.
Department of Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland.
Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Division of Gastroenterology & Hepatology, Washington University School of Medicine, St. Louis, MO, USA.
Digestive Physiology, Hospices Civils de Lyon, Université Lyon I, Univ Lyon, Lyon, France.
Hospices Civils de Lyon, INSERM, LabTAU, Université Lyon I, Univ Lyon, Lyon, France.
National Jewish Health, Denver, Co, USA.
Veteran Affairs San Diego Healthcare System, La Jolla, CA, USA.
Department of Gastroenterology, Neurosciences, Experimental ORL, Neurogastroenterology & Motility, Deglutology - University Hospitals Leuven, University of Leuven, Leuven, Belgium.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
Wingate institute of Neurogastroenterology, Queen Mary University of London, London, UK.
Vanderbilt University Medical Center, Nashville, TN, USA.
CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, INSERM CIC 1401, Université de Bordeaux, Bordeaux, France.
National Center for Global Health and Medicine, Tokyo, Japan.
Sir HN Reliance Foundation Hospital, Mumbai, India.
Div. Gastroenterology, Ege University School of Medicine, Izmir, Turkey.
University of Michigan, Ann Arbor, MI, USA.
Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo. Santiago, Chile.
Flinders University, Adelaide, SA, Australia.
Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Ciudad de México, CDMX, Mexico.
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
University Hospital, University of Chile, Santiago, Chile.
MetroHealth System and case Western Reserve University, Cleveland, OH, USA.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Excellence Center on Neurogastroenterology and Motility, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Pontificia Universidad Javeriana-Hospital San Ignacio, Bogota, Colombia.
Royal Melbourne Hospital, University of Melbourne, Parkville, Vic, Australia.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Weill Cornell Medicine, New York, NY, USA.
Mayo Clinic, Rochester, MN, USA.
Langone Health, New York University, New York, NY, USA.
Monash University, Melbourne, Vic, Australia.
University of Alberta, Edmonton, AB, Canada.
University of Bern, Bern, Switzerland.
Norton Thoracic Institute, Phoenix, AZ, USA.
College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia.
Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Gastroenterology Unit, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
CIBERehd, University Hospital Germans Trias i Pujol, Badalona, Spain.
University College London Hospital, London, UK.
TARGID, University of Leuven, Leuven, Belgium.
Department of Surgery/VA Puget Sound HCS, University of Washington, Seattle, WA, USA.
Bürgerspital Solothurn, University of Bern, Bern, Switzerland.
Bürgerspital Solothurn, University of Zurich, Zurich, Switzerland.
Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Yong Loo Lin of Medicine, National University of Singapore, Singapore, Singapore.
The Chinese University of Hong Kong, Hong Kong SAR.
Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

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.

中文翻译：

高分辨率测压法上的食管动力障碍：芝加哥分类 4.0 版©

芝加哥分类 v4.0 (CCv4.0) 是使用高分辨率测压法 (HRM) 指标对食管运动障碍进行更新的分类方案。分为七个工作小组的 52 名不同的国际专家在两年多的时间里使用经过正式验证的方法来开发 CCv4.0。CCv.4.0 的主要更新包括更严格和更广泛的 HRM 协议，其中包括仰卧和直立测试位置以及激发测试、食管胃交界处 (EGJ) 流出道阻塞 (EGJOO) 的精确定义、更严格的无效食管诊断标准基线 EGJ 指标的运动性和描述。此外，CCv4.0 试图根据相关症状将运动障碍诊断定义为确定性和不确定性，以及关于激发测试的结果以及使用食管钡片和/或功能性管腔成像探头进行支持性测试的结果。这些变化试图最大限度地减少芝加哥分类先前迭代中的歧义，并为 EGJ 的蠕动障碍和阻塞模式提供更标准化和严格的标准。

更新日期：2020-12-29

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