Bredenoord AJ, Fox M, Kahrilas PJ, et al. International High Resolution Manometry Working Group. Chicago classification criteria of esophageal motility disorders defined in high-resolution esophageal pressure topography

Department of Gastroenterology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Neurogastroenterology and Motility (Impact Factor: 3.59). 03/2012; 24 Suppl 1(Suppl 1):57-65. DOI: 10.1111/j.1365-2982.2011.01834.x
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BACKGROUND: The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high resolution esophageal pressure topography (EPT) studies, concurrent with the widespread adoption of this technology into clinical practice. The Chicago Classification has been an evolutionary process, molded first by published evidence pertinent to the clinical interpretation of high resolution manometry (HRM) studies and secondarily by group experience when suitable evidence is lacking. PURPOSE: This publication summarizes the state of our knowledge as of the most recent meeting of the International High Resolution Manometry Working Group in Ascona, Switzerland in April 2011. The prior iteration of the Chicago Classification was updated through a process of literature analysis and discussion. The major changes in this document from the prior iteration are largely attributable to research studies published since the prior iteration, in many cases research conducted in response to prior deliberations of the International High Resolution Manometry Working Group. The classification now includes criteria for subtyping achalasia, EGJ outflow obstruction, motility disorders not observed in normal subjects (Distal esophageal spasm, Hypercontractile esophagus, and Absent peristalsis), and statistically defined peristaltic abnormalities (Weak peristalsis, Frequent failed peristalsis, Rapid contractions with normal latency, and Hypertensive peristalsis). The Chicago Classification is an algorithmic scheme for diagnosis of esophageal motility disorders from clinical EPT studies. Moving forward, we anticipate continuing this process with increased emphasis placed on natural history studies and outcome data based on the classification.

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Available from: Peter J Kahrilas, Oct 20, 2014
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    • "The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical highresolution manometry, concurrent with the widespread adoption of this technology into clinical practice [16]. As far as the UES is concerned, manometry is still complementary to radiology for the diagnosis of disorders. "
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    ABSTRACT: Cricopharyngeal achalasia is an uncommon cause of dysphagia in neonates or children. A nine-year-old female patient was referred to us with a long history of dysphagia, recurrent pulmonary infection and growth stunting. A gastrostomy was introduced to improve her nutritional condition and to minimize potential inflammation in the pharynx. Subsequently, cervical cricopharyngeal myectomy was conducted. The surgical intervention allowed prompt resolution of symptoms without complications. High-resolution manometry post myectomy demonstrated a significant reduction in upper esophageal pressure together with proper relaxation at deglutition. The patient was able to consume solid food and liquid normally, and remained asymptomatic without medications six months after the surgery.
    International Journal of Pediatric Otorhinolaryngology 07/2014; 78(7). DOI:10.1016/j.ijporl.2014.04.036 · 1.19 Impact Factor
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    • "Fifteen healthy subjects, 5 (33.3%) men, median age of 29 years (interquartile range [IQR], 25-31), were enrolled as a control group. Fifteen NOD patients, 6 (40%) men, median age of 61 years (IQR, 51-81), referred to our center for esophageal manometry, were consecutively enrolled, after excluding subjects with systemic diseases which could affect esophageal motility (i.e., diabetes and scleroderma), eosinophylic esophagitis or the following motility disorders, as defined in the Chicago classification17: achalasia, absent peristalsis, esophagogastric junction outflow obstruction, distal esophageal spasm, hypercontractile esophagus and nutcracker esophagus. Finally, 15 patients with achalasia, 8 (53.3%) men, median age of 62 years (IQR, 53-72) successfully treated with pneumatic dilation and routinely followed-up in our center, were consecutively enrolled. "
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    ABSTRACT: Swallowing of cold liquids decreases amplitude and velocity of peristalsis in healthy subjects, using standard manometry. Patients with achalasia and non obstructive dysphagia may have degeneration of sensory neural pathways, affecting motor response to cooling. To elucidate this point, we used high-resolution manometry. Fifteen healthy subjects, 15 non-obstructive dysphagia and 15 achalasia patients, after pneumatic dilation, were studied. The 3 groups underwent eight 5 mL single swallows, two 20 mL multiple rapid swallows and 50 mL intraesophageal water infusion (1 mL/sec), using both water at room temperature and cold water, in a randomized order. In healthy subjects, cold water reduced distal contractile integral in comparison with water at room temperature during single swallows, multiple rapid swallows and intraesophageal infusion (ratio cold/room temperature being 0.67 [95% CI, 0.48-0.85], 0.56 [95% CI, 0.19-0.92] and 0.24 [95% CI, 0.12-0.37], respectively). A similar effect was seen in non-obstructive dysphagia patients (0.68 [95% CI, 0.51-0.84], 0.69 [95% CI, 0.40-0.97] and 0.48 [95% CI, 0.20-0.76], respectively), whereas no changes occurred in achalasia patients (1.06 [95% CI, 0.83-1.29], 1.05 [95% CI, 0.77-1.33] and 1.41 [95% CI, 0.84-2.00], respectively). Our data suggest impairment of esophageal reflexes induced by cold water in patients with achalasia, but not in those with non obstructive dysphagia.
    Journal of neurogastroenterology and motility 01/2014; 20(1):79-86. DOI:10.5056/jnm.2014.20.1.79 · 2.30 Impact Factor
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    • "The parameters of 4 seconds integrated relaxation pressure (IRP), contractile front velocity (CFV), distal latency (DL) and distal contractile integral (DCI) were measured.7 Comparisons were then made between different postures and boluses. "
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    ABSTRACT: Most recent studies using high-resolution manometry were based on supine liquid swallows. This study was to evaluate the differences in esophageal motility for liquid and solid swallows in the upright and supine positions, and to determine the percentages of motility abnormalities in different states. Twenty-four asymptomatic volunteers and 26 patients with gastroesophageal reflux disease underwent high-resolution manometry using a 36-channel manometry catheter. The peristalses of 10 water and 10 steamed bread swallows were recorded in both supine and upright positions. Integrated relaxation pressure, contractile front velocity, distal latency (DL) and the distal contractile integral (DCI) were investigated and comparisons between postures and boluses were analyzed. Abnormal peristalsis of patients was assessed applying the corresponding normative values. In total, 829 swallows from healthy volunteers and 959 swallows from patients were included. (1) The upright position provided lower integrated relaxation pressure, shorter DL and weaker DCI than the supine position. (2) In the comparison of liquid swallows, the mean for contractile front velocity was obviously reduced while DL and DCI were increased in solid swallows. (3) The supine position detected more hypotensive peristalsis than the upright position. The upright position provided more rapid and premature contraction than the supine position but there was no statistically significant difference. Supine solid swallows occur with more hypotensive peristalsis. Analysis should be based on normative values from the corresponding posture and bolus.
    Journal of neurogastroenterology and motility 10/2013; 19(4):467-72. DOI:10.5056/jnm.2013.19.4.467 · 2.30 Impact Factor
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