scholarly journals Novedades acerca de los trastornos motores del esófago tras la reciente clasificación de chicago 4.0

2021 ◽  
Vol 51 (2) ◽  
Author(s):  
Claudia Córdoba ◽  
Agustina Rodil ◽  
Daniel Cisternas
Keyword(s):  
High Resolution ◽  
Incidental Findings ◽  
Esophagogastric Junction ◽  
Outlet Obstruction ◽  
Motor Disorders ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Provocation Tests ◽  
Aggressive Management ◽  
Standardized Diagnostic

The Chicago Classification includes esophageal motor disorders diagnosed by high-resolution manometry. Of the manometric patterns, some are always clinically relevant and require treatment (eg, the achalasia), while others may be incidental findings requiring no intervention in which aggressive management would be counterproductive. One of the goals of the new version of the recently published Chicago Classification (CCv4.0) was to distinguish between clinically relevant and non-clinically relevant disorders. With this in mind, the study protocol was modified to include liquid swallows in the supine and sitting positions and provocation tests were standardized. Diagnostic criteria were modified, incorporating the presence of symptoms and the support of complementary studies other than manometry. In this review, we will comment the diagnosis and treatment of esophagogastric junction outlet obstruction and hypomotility disorders based on CCv4.0.

scholarly journals A pictorial presentation of 3.0 Chicago Classification for esophageal motility disorders

2016 ◽  
Vol 14 (3) ◽  
pp. 439-442 ◽  
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.

scholarly journals Elevated Average Maximum Intrabolus Pressure on High-Resolution Manometry is Associated with Esophageal Dysmotility and Delayed Esophageal Emptying on Timed Barium Esophagram

2021 ◽  
Author(s):  
Katelyn Madigan ◽  
J. Shawn Smith ◽  
Joni Evans ◽  
Steven Clayton
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
Esophageal Dysmotility ◽  
Outflow Obstruction ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Average Maximum ◽  
Barium Esophagram ◽  
Esophageal Emptying ◽  
Liquid Bolus

Abstract Background Intrabolus pressure (IBP) recorded by high-resolution manometry (HRM) portrays the compartmentalized force on a bolus during esophageal peristalsis. HRM may be a reliable screening tool for esophageal dysmotility in patients with elevated average maximum IBP (AM-IBP). Timed barium esophagram (TBE) is a validated measure of esophageal emptying disorders, such as esophagogastric junction outflow obstruction and achalasia. This study aimed to determine if an elevated AM-IBP correlates with esophageal dysmotility on HRM and/or delayed esophageal emptying on TBE. Methods A retrospective analysis of all HRM (unweighted sample n=155) performed at a tertiary referral center from 09/2015-03/2017 yielded a case group (n=114) with abnormal AM-IBP and a control group (n=41) with a normal AM-IBP (pressure<17mmHg) as consistent with Chicago Classification 3. All patients received a standardized TBE, with abnormalities classified as greater than 1 cm of retained residual liquid barium in the esophagus at 1 and 5 minutes or as tablet retention after 5 minutes. Results AM-IBP was significantly related to liquid barium retention (p=0.003) and tablet arrest on timed barium esophagram (p=0.011). A logistic regression model correctly predicted tablet arrest in 63% of cases. Tablet arrest on AM-IBP correlated with an optimal prediction point at 20.1 mmHg on HRM. Patients with elevated AM-IBP were more likely to have underlying esophageal dysmotility (95.6% vs. 70.7% respectively; p<0.001), particularly esophagogastric junction outflow obstruction disorders. Elevated AM-IBP was associated with incomplete liquid bolus transit on impedance analysis (p=0.002). Conclusions Our findings demonstrate that an elevated AM-IBP is associated with abnormal TBE findings of esophageal tablet retention and/or bolus stasis. An abnormal AM-IBP (greater than 20.1 mm Hg) was associated with a higher probability of retaining liquid bolus or barium tablet arrest on TBE and esophageal dysmotility on HRM. This finding supports the recent incorporation of IBP in Chicago Classification v4.0.

scholarly journals Physiological and pathological roles of the accommodation response in lower esophageal sphincter relaxation during wet swallows

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazumasa Muta ◽  
Eikichi Ihara ◽  
Shohei Hamada ◽  
Hiroko Ikeda ◽  
Masafumi Wada ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Resolution ◽  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Relaxation Function ◽  
Esophagogastric Junction ◽  
Prospective Observational Study ◽  
Outflow Obstruction ◽  
High Resolution Manometry ◽  
Esophageal Sphincter

AbstractThe preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, however, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. To address this problem, we conducted a prospective observational study of 38 patients with normal high-resolution manometry (HRM) and 23 patients with idiopathic esophagogastric junction outflow obstruction (EGJOO) to assess dry and wet swallows. The LES accommodation measurement was proposed for practical use in evaluating the LES accommodation response. Although swallow-induced LES relaxation was observed in both dry and wet swallows, LES accommodation (6.4, 3.1–11.1 mmHg) was only observed in wet swallows. The extent of LES accommodation was impaired in idiopathic EGJOO (0.6, − 0.6–6 mmHg), and the LES accommodation measurement of patients with idiopathic EGJOO (36.8, 29.5–44.3 mmHg) was significantly higher in comparison to those with normal HRM (23.8, 18–28.6 mmHg). Successful LES relaxation in wet swallowing can be achieved by LES accommodation in combination with swallow-induced LES relaxation. Impaired LES accommodation is characteristic of idiopathic EGJOO. In addition to the IRP value, the LES accommodation measurement may be useful for evaluating the LES relaxation function in clinical practice.

scholarly journals How Updates in Chicago Classification Impact Clinical Practice

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.

scholarly journals 3D-high resolution manometry of the esophagogastric junction

2011 ◽  
Vol 23 (11) ◽  
pp. e461-e469 ◽  
Author(s):  
M. A. Kwiatek ◽  
J. E. Pandolfino ◽  
P. J. Kahrilas
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
High Resolution Manometry

scholarly journals Novel 3D high-resolution manometry metrics for quantifying esophagogastric junction contractility

2017 ◽  
Vol 29 (8) ◽  
pp. e13054 ◽  
Author(s):  
Zhiyue Lin ◽  
Yinglian Xiao ◽  
Yuwen Li ◽  
John E. Pandolfino ◽  
Minhu Chen ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
High Resolution Manometry

The Value of High-Resolution Manometry in Measurement of EGJ Competency and Manometric Outcomes of Antireflux Surgery

2021 ◽  
Vol 1 (3) ◽  
pp. 227-233
Author(s):  
Sumeet K. Mittal ◽  
Komeil Mirzaei Baboli
Keyword(s):  
High Resolution ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Antireflux Surgery ◽  
Esophagogastric Junction ◽  
Normal Values ◽  
Pressure Profile ◽  
Objective Measures ◽  
High Resolution Manometry ◽  
Integral Role

The esophagogastric junction (EGJ) barrier plays an integral role in the prevention of gastroesophageal reflux; however, not much attention has been paid to competency parameters, especially in the era of high-resolution manometry (HRM). HRM provides a unique spatiotemporal pressure profile and measurements of the EGJ. Herein, we discuss the evidence for objective measures of EGJ competency, which should guide the clinical management of gastroesophageal reflux disease. Additionally, we will briefly discuss expected normal values after antireflux surgery.

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