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
Source: PubMed


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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    • "All patients were interviewed over the phone 2–3 times before follow-up in order to encourage adequate IQS training . The effect of IQS traction on pressure in the upper esophageal sphincter (UES) and the diaphragmatic hiatus (DH) was determined on 12 patients with hiatal hernia using high resolution manometry (HRM) [10]. "
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    ABSTRACT: Misdirected swallowing can be triggered by esophageal retention and hiatal incompetence. The results show that oral IQoro(R) screen (IQS) training improves misdirected swallowing, hoarseness, cough, esophageal retention, and globus symptoms in patients with hiatal hernia. The present study investigated whether muscle training with an IQS influences symptoms of misdirected swallowing and esophageal retention in patients with hiatal hernia. A total of 28 adult patients with hiatal hernia suffering from misdirected swallowing and esophageal retention symptoms for more than 1 year before entry to the study were evaluated before and after training with an IQS. The patients had to fill out a questionnaire regarding symptoms of misdirected swallowing, hoarseness, cough, esophageal retention, and suprasternal globus, which were scored from 0-3, and a VAS on the ability to swallow food. The effect of IQS traction on diaphragmatic hiatus (DH) pressure was recorded in 12 patients with hiatal hernia using high resolution manometry (HRM). Upon entry into the study, misdirected swallowing, globus sensation, and esophageal retention symptoms were present in all 28 patients, hoarseness in 79%, and cough in 86%. Significant improvement was found for all symptoms after oral IQS training (p < 0.001). Traction with an IQS resulted in a 65 mmHg increase in the mean HRM pressure of the DH.
    Full-text · Article · Jul 2015 · Acta oto-laryngologica
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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.
    Full-text · Article · Jul 2014 · International Journal of Pediatric Otorhinolaryngology
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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.
    Full-text · Article · Jan 2014 · Journal of neurogastroenterology and motility
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