Does the Chicago Classification Alter the Management of Patients With Suspected Esophageal Motor Disorders?

Anumandla, Ashwini; Bethards, Deborah; Ouyang, Ann

doi:10.1016/s0016-5085(11)61196-7

Cited by 6 publications

(5 citation statements)

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“…Despite these advances, HRM studies still have limitations. For example, at least 20% of patients with swallowing disorders have normal findings on HRM and, conversely, abnormal motility detected during single water swallows is only weakly associated with symptoms or outcomes . These limitations may, in part, be due to investigation in a nonphysiological position.…”

Section: Introductionmentioning

confidence: 99%

“…For example, at least 20% of patients with swallowing disorders have normal findings on HRM 4 and, conversely, abnormal motility detected during single water swallows is only weakly associated with symptoms or outcomes. 11,12 These limitations may, in part, be due to investigation in a nonphysiological position. Humans rarely drink or eat lying down and investigations in the upright position are easier to perform and favoured by patients.…”

Section: Introductionmentioning

confidence: 99%

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Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high‐resolution manometry

Misselwitz

Hollenstein

Bütikofer

et al. 2020

Aliment Pharmacol Ther

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Summary Background Standard high‐resolution manometry (HRM) protocols are based on 10 single water swallows acquired in the supine position. Aims To assess the impact of position, rapid drink challenge and solid test meal on the diagnosis of oesophageal motility disorders. Methods Seventy‐two healthy volunteers (20‐76 years) and 366 consecutive patients (18‐90 years) completed HRM with 10 single water swallows in the supine and upright positions. Rapid drink challenge was performed twice, before and after the solid test meal. Diagnosis based on single water swallows in the supine position (Chicago Classification v3.0) was compared with results in the upright position and with provocative tests. Results Overall, diagnostic agreement in the supine and upright positions was present in 296/438 (67.6%) subjects. This increased to 90.0% when ineffective oesophageal motility was considered with normal motility. Integrated relaxation pressure was 4 mm Hg higher in the supine position. There was a higher prevalence of inconsistent, likely false positive, diagnoses of outlet obstruction in the supine compared to the upright position (16/20 vs 1/4 patients, P = 0.0007). Similarly, the difference in concordance for the diagnosis of oesophago‐gastric junction obstruction or achalasia between single water swallows in the supine and upright positions with solid test meal was significant (12/29 (41.4%) vs 12/14 (85.7%), P = 0.0087). Conclusion Diagnostic agreement for oesophageal motility disorders based on single water swallows in the upright and supine positions was moderate, with frequent discordant findings for ineffective motility and outlet obstruction. HRM studies can be performed in either position, using appropriate reference values. Rapid drink challenge or solid test meal can resolve diagnostic discrepancies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high‐resolution manometry

Misselwitz

Hollenstein

Bütikofer

et al. 2020

Aliment Pharmacol Ther

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show abstract

“…This may be because manometric studies with five to eight pressure sensors have low sensitivity and/or because small volume water swallows are not representative of normal drinking and eating behavior and very rarely trigger symptoms. Indeed, failure to ‘challenge’ esophageal function during manometry studies may explain why many diagnoses based on the Chicago Classification of esophageal dysmotility do not predict symptom severity or alter management …”

Section: Introductionmentioning

confidence: 99%

Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: development and clinical validation of a new methodology utilizing high‐resolution manometry

Sweis

Anggiansah

Wong

et al. 2013

Neurogastroenterology Motil

123

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“…Despite these advances, HRM studies still have limitations. For example, at least 20% of patients with swallowing disorders have normal findings on HRM [8], and conversely, abnormal motility detected during single water swallows is only weakly associated with symptoms or outcomes [20,21]. These limitations may be due in part to investigation in a non-physiological position, as the standard is to measure patients while supine in order to exclude gravity; people rarely drink or eat lying down, however, and investigations in the upright position are easier to perform and favoured by patients [22,23].…”

Section: Chicago Classificationmentioning

confidence: 99%

High-Resolution Manometry—Observations After 15 Years of Personal Use—Has Advancement Reached a Plateau?

Sweis

Fox

2020

Curr Gastroenterol Rep

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Purpose of Review In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the cause of symptoms, identify pathology and guide effective management. One of the most notable recent advances in the field of oesophageal function has been high-resolution manometry (HRM). This review explores how innovation in HRM has progressed and has far from reached a plateau. Recent Findings HRM technology, methodology and utility continue to evolve; simple additions to the swallow protocol (e.g. eating and drinking), shifting position, targeting symptoms and adding impedance sensors to the HRM catheter have led to improved diagnoses, therapeutic decision-making and outcomes. Summary Progress in HRM persists and shows little sign of abating. The next iteration of the Chicago Classification of motor disorders will highlight these advances and will also identify opportunities for further research and innovation.

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Does the Chicago Classification Alter the Management of Patients With Suspected Esophageal Motor Disorders?

Cited by 6 publications

References 0 publications

Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high‐resolution manometry

Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high‐resolution manometry

Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: development and clinical validation of a new methodology utilizing high‐resolution manometry

High-Resolution Manometry—Observations After 15 Years of Personal Use—Has Advancement Reached a Plateau?

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