Esophageal motility disorder - has Chicago classification v4.0 simplified our management?
Journal
Current opinion in otolaryngology & head and neck surgery
ISSN: 1531-6998
Titre abrégé: Curr Opin Otolaryngol Head Neck Surg
Pays: United States
ID NLM: 9417024
Informations de publication
Date de publication:
01 Dec 2023
01 Dec 2023
Historique:
medline:
3
11
2023
pubmed:
11
10
2023
entrez:
11
10
2023
Statut:
ppublish
Résumé
Addressing dysphagia is vital due to its prevalence and impact on healthcare expenditure. While high resolution manometry (HRM) effectively evaluates esophageal dysphagia, its role in oropharyngeal dysphagia and upper esophageal sphincter (UES) dysfunction remains debated. The fourth iteration of the Chicago classification (CC) offers an algorithmic approach for diagnosing abnormal motor patterns via HRM. This review assesses the CC's impact on dysphagia management. The Chicago classification version 4.0 emphasizes auxiliary and provocative techniques when the algorithm falls short of a conclusive diagnosis. It introduces stricter criteria for previously ambiguous conditions like ineffective motility and esophagogastric junction outflow obstruction. This version also introduces the concept of conclusive and inconclusive classifications based on symptoms, provocation maneuvers, and supportive testing minimizing ambiguity. The Chicago classification v4.0 remains a useful tool for the diagnosis of well characterized esophageal motility disorders. However, major limitations include reliance on HRM and a focus on distal esophagus contractile characteristics without considering proximal esophagus or upper esophageal sphincter, both of which can sometimes be the only evident abnormality in patients with dysphagia. Despite efforts to reduce ambiguity, diagnostic challenges persist. These limitations can be addressed in future updates.
Identifiants
pubmed: 37820073
doi: 10.1097/MOO.0000000000000936
pii: 00020840-990000000-00088
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
374-381Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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