Korean J Gastroenterol.  2022 Feb;79(2):55-60. 10.4166/kjg.2022.015.

Chicago Classification ver. 4.0: An Overview of Esophageal Motility Disorders on High-resolution Manometry

• Lee TH

• KMID: 2526791
• DOI: http://doi.org/10.4166/kjg.2022.015

Abstract

This review introduces the updated Chicago Classification ver. 4.0 for esophageal motility disorders using metrics from high-resolution manometry (HRM). The Chicago Classification ver. 4.0 was developed by 52 diverse international experts using validated methodologies over 2 years. Key updates in Chicago Classification ver. 4.0 include: 1) a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, 2) a refined definition of esophagogastric junction outflow obstruction, and 3) emphasis on supportive testing with barium esophagogram with tablet and/or functional lumen imaging probe.

Keyword

Esophageal motility disorders; Manometry; Deglutition disorders; Chest pain

Figure

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  Fig. 1 Rapid drink challenge (RDC) test discriminating type 3 achalasia from distal esophageal spasm. (A) Upper endoscopy suggests the achalasia. (B) Standard protocol shows distal esophageal spasm. (C) RDC reveals the presence of outflow obstruction.

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  Fig. 2 Solid test swallows revealing underlying esophagogastric junction outflow disorder in a 62-year-old male with 4-months-duration dysphagia

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