The Chicago Classification of esophageal motility disorders, v3.0

TLDR

Chicago Classification of esophageal motility disorders is an algorithmic scheme for analyzing high‑resolution manometry studies that has gained worldwide acceptance. The 2014 update, CC v3.0, was developed by the International HRM Working Group and incorporates extensive clinical experience and interval publications since the 2011 version. CC v3.0 introduces a hierarchical diagnostic framework that prioritizes esophagogastric junction outflow disorders, major peristaltic disorders, and minor peristaltic disorders, adds EGJ morphology assessment, fragmented contractions, and ineffective esophageal motility, while retaining IRP, DCI, and DL metrics with greater emphasis on DCI, and removes contractile front velocity and small breaks from the criteria.

Abstract

Abstract Background The Chicago Classification ( CC ) of esophageal motility disorders, utilizing an algorithmic scheme to analyze clinical high‐resolution manometry ( HRM ) studies, has gained acceptance worldwide. Methods This 2014 update, CC v3.0, developed by the International HRM Working Group, incorporated the extensive clinical experience and interval publications since the prior (2011) version. Key Results Chicago Classification v3.0 utilizes a hierarchical approach, sequentially prioritizing: (i) disorders of esophagogastric junction ( EGJ ) outflow (achalasia subtypes I‐III and EGJ outflow obstruction), (ii) major disorders of peristalsis (absent contractility, distal esophageal spasm, hypercontractile esophagus), and (iii) minor disorders of peristalsis characterized by impaired bolus transit. EGJ morphology, characterized by the degree of overlap between the lower esophageal sphincter and the crural diaphragm and baseline EGJ contractility are also part of CC v3.0. Compared to the previous CC version, the key metrics of interpretation, the integrated relaxation pressure ( IRP ), the distal contractile integral ( DCI ), and the distal latency ( DL ) remain unchanged, albeit with much more emphasis on DCI for defining both hypo‐ and hypercontractility. New in CC v3.0 are: (i) the evaluation of the EGJ at rest defined in terms of morphology and contractility, (ii) ‘fragmented’ contractions (large breaks in the 20‐mmHg isobaric contour), (iii) ineffective esophageal motility ( IEM ), and (iv) several minor adjustments in nomenclature and defining criteria. Absent in CC v3.0 are contractile front velocity and small breaks in the 20‐mmHg isobaric contour as defining characteristics. Conclusions & Inferences Chicago Classification v3.0 is an updated analysis scheme for clinical esophageal HRM recordings developed by the International HRM Working Group.