The Chicago criteria for esophageal motility disorders: what has changed in the past 5 years?
ABSTRACT The Chicago Classification for esophageal motility disorders was developed to complement the enhanced characterization of esophageal motility provided by high-resolution esophageal pressure topography (HREPT) as this new technology has emerged within clinical practice. This review aims to summarize the evidence supporting the evolution of the classification scheme since its inception.
Studies examining the specific esophageal motility disorders in regards to HREPT metrics, clinical characteristics, and responses to treatments have facilitated updates of the diagnostic scheme and criteria. These studies have demonstrated variation in treatment responses associated with subclassification of achalasia, the use of distal latency in the diagnosis of distal esophageal spasm, and the development of diagnoses including esophagogastric junction outflow obstruction and hypercontractile esophagus.
The diagnostic criteria described in the Chicago Classification have evolved to demonstrate a greater focus on distinct clinical phenotypes. Future evaluation of the natural history and treatment outcomes will assist in further refinement of this diagnostic scheme and management of esophageal motility disorders.
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ABSTRACT: Achalasia is a primary neurodegenerative disorder of the esophagus characterized by loss of function of the lower esophageal sphincter (LES) and of esophageal peristalsis, which causes symptoms such as dysphagia, regurgitation, weight loss, and chest pain. Esophageal manometry is the gold standard for the diagnosis of achalasia. The typical manometric features are incomplete relaxation of a frequently hypertensive LES and lack of peristalsis in the tubular esophagus. High-resolution manometry using catheters with 36 solid-state sensors spaced 1cm apart has more and more replaced water-perfused and pull-through manometry. However, the main innovation of this method is the conversion of pressure data into a topographical plot. The data can be modified using interpolation to generate high-resolution esophageal pressure topography (HREPT). HREPT is more sensitive, provides more detailed information, and is easier to perform than conventional manometry. Introduction of HREPT had an impact especially on the diagnosis and management of achalasia. A clinically relevant impact was achieved by the identification of 3 clinical subtypes which seem to predict treatment outcomes. This review analyzes the progress made in the diagnosis and management of achalasia since the recent introduction of HREPT.
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ABSTRACT: Achalasia is a primary esophageal motility disorder characterized by the absence of primary peristalsis and a failure of the lower esophageal sphincter to relax, resulting in a dilated esophagus. Dysphagia is the classic and most common symptom. Respiratory obstruction due to tracheal compression caused by a massively dilated esophagus is a very rare but fatal complication. Herein, we report a case of a patient with long-standing achalasia who had tracheal compression secondary to a markedly dilated, giant esophagus. These findings are documented with CT scans. His symptoms regressed after a Heller myotomy and fundoplication operation.
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ABSTRACT: Background Relaxation of the esophagogastric junction (EGJ) is now evaluated calculating 4-second integrated relaxation pressure (4-s IRP) by high resolution manometry (HREPT). Solid-state catheters have been used to define abnormal values. Our aim was to evaluate 4-s IRP in esophageal achalasia using HREPT with perfused catheters.Methods From June 2009 to June 2013, 936 HREPT studies have been performed in our unit. Of these, 194 patients having treated achalasia were excluded. Control group was constituted by 695 patients without achalasia, and 47 patients with untreated achalasia constituted the study group. HREPT was performed with water-perfused catheters. To establish the cut-off value for 4-s IRP that better discriminate patients with achalasia from all other patients, a receiver operating characteristic (ROC) analysis was performed.Key ResultsTwenty three of 47 achalasia patients (49%) showed a 4-s IRP under 15 mmHg; and seven (15%) had a value under modified Chicago criteria. A cut-off value for 4-s IRP of 6.5 mmHg, calculated by ROC analysis, highly discriminates achalasia from the rest of the patients and especially from scleroderma patients (area under the curve: 0.997, 95% CI: 0.995–1.000; p < 0.001).Conclusions & InferencesCut-off values for 4-s IRP defined using HREPT with solid-state catheters are not adequate for diagnosing esophageal achalasia with water-perfused systems. A lower value, i.e., 6.5 mmHg, is suggested for this equipment. The diagnostic criteria of esophageal achalasia should be modified for HREPT performed with water-perfused systems.Neurogastroenterology and Motility 08/2014; 26(11). DOI:10.1111/nmo.12415 · 2.94 Impact Factor