Does Chicago Classification address Symptom Correlation with High-resolution Esophageal Manometry?

ABSTRACT Aim To assess the correlation of symptoms with findings on esophageal high-resolution manometry (HRM) in Indian patients. Materials and methods Prospective data collection of all patients undergoing esophageal manometry was done at two centers in India—Indore and Chennai—over a period of 18 months. Symptom profile of the study group was divided into four: Motor dysphagia, noncardiac chest pain (NCCP), gastroesophageal reflux (GER), and esophageal belchers. The symptoms were correlated with manometric findings. Results Of the study group (154), 35.71% patients had a normal study, while major and minor peristaltic disorders were noted in 31.16 and 33.76% respectively. In patients with symptoms of dysphagia, achalasia cardia was the commonest cause (45.1%), followed by ineffective esophageal motility (IEM) (22.53%) and normal study (19.71%). In patients with NCCP, normal peristalsis (50%) and ineffective motility (31.25%) formed the major diagnosis. Of the 56 patients with GER symptoms, 26 (46.4%) had normal manometry. An equal number had ineffective motility. Of the 11 esophageal belchers, 7 (63.6%) of these had a normal study and 3 had major motility disorder. Dysphagia was the only symptom to have a high likelihood ratio and positive predictive value to pick up major motility disorder. Conclusion Dysphagia correlates with high chance to pick up a major peristaltic abnormality in motor dysphagia. The role of manometry in other symptoms in Indian setting needs to be ascertained by larger studies. Clinical significance The present study highlights lack of symptom correlation with manometry findings in Indian patients. How to cite this article Jain M, Srinivas M, Bawane P, Venkataraman J. Does Chicago Classification address Symptom Correlation with High-resolution Esophageal Manometry? Euroasian J Hepato-Gastroenterol 2017;7(2):122-125.

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Spectrum of Esophageal Motility Disorders in Patients with Motor Dysphagia and Noncardiac Chest Pain ‑ A Single Center Experience

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_85_16 ◽

2017 ◽

Vol 08 (02) ◽

pp. 068-071

Author(s):

Rinkesh Kumar Bansal ◽

Mukesh Nasa ◽

Gaurav Kumar Patil ◽

Vinit Shah ◽

Narendra S. Choudhary ◽

...

Keyword(s):

Chest Pain ◽

High Resolution ◽

Esophageal Motility ◽

Esophageal Manometry ◽

Motility Disorder ◽

Esophageal Motility Disorders ◽

Noncardiac Chest Pain ◽

Esophageal Motility Disorder ◽

Motility Disorders ◽

High Resolution Manometry

ABSTRACT Aims and Objective: High‑resolution esophageal manometry is the most important investigation for the evaluation of patients with dysphagia and noncardiac chest pain (NCCP). Chicago Classification (CC) utilizing an algorithmic approach in analyzing high‑resolution manometry has been accepted worldwide, and an updated version, CC v3.0, of this classification has been developed by the International high‑resolution manometry working Group in 2014. Data on the spectrum of esophageal motility disorders in Indian population are scarce as well as a newer version of CC has not been used to classify. The aim of our study is to evaluate clinical presentation and manometric profile of patients with suspected esophageal motility disorders using CC v3.0. Methodology: In this retrospective study, consecutive patients referred for esophageal manometry at our center from 2010 to 2015 were included in the study. High‑resolution esophageal manometry was performed with 22‑channel water‑perfusion system (MMS, The Netherlands). Newer version of CC (CC v3.0) was used to classify motility disorders. Results: A total of 400 patients were included, with a mean age of 44 years and 67.5% were males. Out of these, 60% (n = 240) patients presented with motor dysphagia while 40% (n = 160) had NCCP. Motility disorder was present in 50.5% (n = 202) of the patients while 49.5% (n = 198) patients had normal manometry. Disorders of esophagogastric junction outflow were the predominant type of disorder, found in 33.75% (n = 135). About 14.25% (n = 57) of the patients had minor disorders of peristalsis while 5% (n = 20) of the patients had other major disorders of peristalsis. Achalasia was the most common motility disorder present in 30% (n = 120) patients. Conclusion: Dysphagia was the most common esophageal symptom followed by NCCP in our series. Achalasia was the most common esophageal motility disorder followed by fragmented peristalsis.

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The Effect of Diet Composition Change on High-Resolution Oesophageal Manometry Metrics in Non-Erosive Gastroesophageal Reflux Disease Patients

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_054 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 54-54

Author(s):

Sergey Morozov ◽

Vasily Isakov

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

Esophageal Manometry ◽

Diet Composition ◽

Control Group ◽

Study Group ◽

Ineffective Esophageal Motility ◽

Dietary Fiber Intake ◽

Significant Difference ◽

Resting Pressure

Abstract Objectives To evaluate the influence of change of diet composition on esophageal manometry metrics. Methods The data of 43 NERD patients with low (<20 g/day) baseline dietary fiber intake served as a source data. These patients were examined with the use of standard food frequency questionnaire and high-resolution esophageal manometry. Thirty of them received psyllium 5.0 g TID 10 days in addition of their usual diet within registered clinical trial (NCT01882088). The other 13 were found in the database by diagnosis; their data were eligible in case of the presence of repeated high-resolution esophageal manometry examination and dietary assessments at the same time point and if no significant change in diet composition was revealed. The changes were assessed in accordance to Chicago classification 3.0. Non-parametric statistics (Wilcoxon matched pairs test, Mann-Whitney U-test) were used to assess the change in HRM metrics in these groups. Results In those who received psyllium, significant increase of minimal lower esophageal resting pressure at rest and after 10 water swallows was registered: 5.41 ± 10.1 vs 11.3 ± 9.4 mm Hg, P = 0.023 and 14.1 ± 8.0 vs 14.9 ± 6.4 mm Hg, P = 0.008, accordingly. No significant difference was found in the group with no change of diet composition by these parameters. At baseline, ineffective esophageal motility was found in 46.7% patients of the study group and 53.8% in the control group (P = 0.7). Esophageal motility became normal in 71.4% of those who had IEM initially in the study group after 10 days of treatment, and in 14.3% among the controls (P = 0.0135). This type of peristaltic abnormality was found not changed in 28.6% of the study group and in 85.7% among the control group, P = 0.014. New cases of ineffective esophageal motility revealed in 12.5% of the study group and 16.7% among the controls (P = 0.8) Conclusions Change of diet composition by additional quantity of psyllium may result in the improvement of esophageal motility. Funding Sources Federal Research Center of Nutrition and Biotechnology.

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A pictorial presentation of 3.0 Chicago Classification for esophageal motility disorders

Einstein (São Paulo) ◽

10.1590/s1679-45082016md3444 ◽

2016 ◽

Vol 14 (3) ◽

pp. 439-442 ◽

Cited By ~ 8

Author(s):

Fernando Augusto Herbella ◽

Priscila Rodrigues Armijo ◽

Marco Giuseppe Patti

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

Esophagogastric Junction ◽

Esophageal Motility Disorders ◽

Motility Disorders ◽

High Resolution Manometry ◽

Ineffective Esophageal Motility ◽

Chicago Classification ◽

Esophageal Spasm ◽

Pictorial Presentation

ABSTRACT High resolution manometry changed several esophageal motility paradigms. The 3.0 Chicago Classification defined manometric criteria for named esophageal motility disorders. We present a pictorial atlas of motility disorders. Achalasia types, esophagogastric junction obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus (jackhammer), ineffective esophageal motility, and fragmented peristalsis are depicted with high-resolution manometry plots.

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Chicago classification version 4.0 © technical review: Update on standard high‐resolution manometry protocol for the assessment of esophageal motility

Neurogastroenterology & Motility ◽

10.1111/nmo.14120 ◽

2021 ◽

Vol 33 (4) ◽

Author(s):

Mark R. Fox ◽

Rami Sweis ◽

Rena Yadlapati ◽

John Pandolfino ◽

Albis Hani ◽

...

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

High Resolution Manometry ◽

Chicago Classification ◽

Technical Review

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How Updates in Chicago Classification Impact Clinical Practice

Foregut: The Journal of the American Foregut Society ◽

10.1177/26345161211039851 ◽

2021 ◽

pp. 263451612110398

Author(s):

Rena Yadlapati ◽

Peter J. Kahrilas

Keyword(s):

Clinical Practice ◽

High Resolution ◽

Patient Outcomes ◽

Clinical Application ◽

High Resolution Manometry ◽

Chicago Classification

Chicago Classification version 4.0 (CC v4.0), published in 2021, presents several modifications largely aimed at minimizing over-diagnosis of inconclusive patterns on high-resolution manometry (HRM). These include: (1) introduction of a standardized HRM protocol for consistency among centers, (2) emphasis on the need for supportive data in instances of inconclusive manometric patterns, (3) required presence of relevant symptoms in certain instances to reduce over-diagnosis and inappropriate interventions, and (4) classification as disorders of EGJ outflow or disorders of peristalsis. These updates aim to improve the clinical application of HRM and patient outcomes.

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High-Resolution Esophageal Manometry: A Time Motion Study

Canadian Journal of Gastroenterology ◽

10.1155/2008/737062 ◽

2008 ◽

Vol 22 (4) ◽

pp. 365-368 ◽

Cited By ~ 13

Author(s):

Daniel C Sadowski ◽

Linda Broenink

Keyword(s):

High Resolution ◽

Esophageal Manometry ◽

Clinical Investigation ◽

Study Quality ◽

Procedure Time ◽

High Resolution Manometry ◽

Time Motion ◽

Motion Study ◽

Significant Difference ◽

End Times

INTRODUCTION: High-resolution manometry (HRM) of the esophagus is a new technique that provides a more precise assessment of esophageal motility than conventional techniques. Because HRM measures pressure events along the entire length of the esophagus simultaneously, clinical procedure time should be shorter because less catheter manipulation is required. According to manufacturer advertising, the new HRM system is more accurate and up to 50% faster than conventional methods.OBJECTIVE: To test the hypothesis that clinical testing with HRM requires less procedural time than a standard water perfusion (WP) method.METHODS: Forty-one consecutive patients were studied (20 underwent WP and 21 underwent HRM). Using time-motion analysis, the start and end times for each task associated with performing the study were recorded. Patient discomfort and study quality were also assessed by using five- and four-point qualitative scales, respectively.RESULTS: Total procedure time was reduced on average by 25.6% in the HRM group (from 41.8 minutes with WP to 30.7 minutes with HRM, P<0.05). There was no significant difference in the discomfort scores reported by the study subjects and no difference in study quality.CONCLUSIONS: HRM requires less time to complete than conventional manometry and should therefore shorten the wait-times of patients scheduled for esophageal manometry and have a significant impact on the cost of performing this commonly used clinical investigation.

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P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION

Diseases of the Esophagus ◽

10.1093/dote/doz092.173 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Carlo Galdino Riva ◽

Stefano Siboni ◽

Veronica Lazzari ◽

Marco Sozzi ◽

Emanuele Asti ◽

...

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

Symptom Relief ◽

Rank Test ◽

Barium Swallow ◽

Upper Gastrointestinal Endoscopy ◽

Magnetic Sphincter Augmentation ◽

Hrql Score ◽

High Resolution Manometry ◽

Ineffective Esophageal Motility

Abstract Aim The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD). Background and Methods MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test. Results Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients. Conclusion MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.

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