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. Purpose 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 CC v3.0 utilizes a hierarchical approach, sequentially prioritizing: 1) disorders of esophagogastric junction (EGJ) outflow (achalasia subtypes I–III and EGJ outflow obstruction), 2) major disorders of peristalsis (absent contractility, distal esophageal spasm, hypercontractile esophagus), and 3) 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: 1) the evaluation of the EGJ at rest defined in terms of morphology and contractility, 2) ‘fragmented’ contractions (large breaks in the 20-mmHg isobaric contour), 3) ineffective esophageal motility (IEM), and 4) several minor adjustments in nomenclature and defining criteria. Absent in CC v3.0 are contractile front velocity (CFV) and small breaks in the 20-mmHg isobaric contour as defining characteristics. Conclusion CC v3.0 is an updated analysis scheme for clinical esophageal HRM recordings developed by the International HRM Working Group.

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In this large study, we found robust data on increasing incidence rates of pediatric and adult EoE in the past 15 years. This rapidly increasing incidence has not reached a plateau yet.

During the natural course of EoE, progression from an inflammatory to a fibrostenotic phenotype occurs. With each additional year of undiagnosed EoE the risk of stricture presence increases with 9%.

Most HRM parameters assessed in this study resemble the previously described values on which the current criteria are based, supporting the widespread use of these criteria for clinical purposes. However, vigor of the esophageal contraction was lower and transition zone length larger than in previous reports. Peristaltic breaks occur frequently in healthy subjects.