Ineffective Esophageal Motility Is Associated with Impaired Bolus Clearance but Does Not Correlate with Severity of Dysphagia

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429

Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high‐resolution manometry (HRM). Fifty‐two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two‐years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.

Section: Additional Considerations For Ineffective Esophageal Motilitymentioning

confidence: 99%

Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0^©

Yadlapati

Kahrilas

Fox

et al. 2020

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429

“…The clinical significance of IEM remains unclear because most studies failed to find any correlation with symptoms 2‐6,9,19 . In the study by Jain et.…”

Section: Discussionmentioning

confidence: 99%

“…The definition of ineffective esophageal motility (IEM) has evolved during the last decades and remains a matter of debate. Indeed, IEM as diagnosed by high‐resolution manometry (HRM) is considered as a minor motility disorder as it can be observed in a significant proportion of healthy subjects 1 and is not clearly correlated to symptoms 2‐6 …”

Section: Introductionmentioning

confidence: 99%

Ineffective esophageal motility and bolus clearance. A study with combined high‐resolution manometry and impedance in asymptomatic controls and patients

Zerbib

Marín

Cisternas

et al. 2020

Background The definition and relevance of ineffective esophageal motility (IEM) remains debated. Our aim was to determine motility patterns and symptoms associated with IEM defined as impaired bolus clearance. Methods To define altered bolus clearance, normal range of swallows with complete bolus transit (CBT) on high‐resolution impedance manometry (HRIM) was determined in 44 asymptomatic controls. The results were then applied to a cohort of 81 patients with esophageal symptoms to determine the motility patterns which best predicted altered bolus clearance. Subsequently, in a cohort of 281 consecutive patients the identified motility patterns were compared with patients’ customary symptoms. Key Results In asymptomatic controls, the normal range of swallows with CBT was 50%‐100%. In patients, altered bolus transit (<50% CBT) was only associated with 30% or more failed contractions (P < .001). Neither weak peristalsis nor absence of contraction reserve (CR) was associated with altered bolus clearance. The patterns which best predicted altered bolus clearance were failed contractions ≥30% (specificity 88.2% and sensitivity of 84.6%), and ≥70% ineffective (failed + weak) contractions (sensitivity 84.6% and specificity 80.9%). No motility pattern was correlated to symptom scores. Conclusions and Inferences Based on bolus clearance assessed by HRIM, ≥30% failed contractions and ≥70% ineffective contractions have the best sensitivity and specificity to predict altered bolus clearance. Weak contractions and absence of CR are not relevant with respect to bolus clearance.

“…Over the past 20 years, high‐resolution manometry (HRM) has become the gold standard for the diagnosis of esophageal motility disorders. The current HRM‐based Chicago classification v3.0 (CC 3.0) 1 makes a distinction between major (achalasia, EGJ outflow obstruction, esophageal spasms, Jackhammer esophagus, and absent contractility) and minor motility disorders (ineffective esophageal motility) of uncertain clinical signification since they can be observed in a significant proportion of healthy subjects and are not clearly correlated with symptoms 2–6 . Consequently, a significant proportion of patients with esophageal symptoms have a normal HRM or an inconclusive diagnosis, therefore without definite explanation for their symptoms nor proposition for management 7,8 .…”

Section: Introductionmentioning

confidence: 99%

The added value of symptom analysis during a rapid drink challenge in high‐resolution esophageal manometry

Zerbib

Luna

Marín

et al. 2020

Over the past 20 years, high-resolution manometry (HRM) has become the gold standard for the diagnosis of esophageal motility disorders. The current HRM-based Chicago classification v3.0 (CC 3.0) 1 makes a distinction between major (achalasia, EGJ outflow obstruction, esophageal spasms, Jackhammer esophagus, and absent contractility) and minor motility disorders (ineffective esophageal motility) of uncertain clinical signification since they can be observed in a significant proportion of healthy subjects and are not clearly correlated with symptoms. 2-6 Consequently, a significant proportion of patients with esophageal symptoms have a normal HRM or an inconclusive diagnosis, therefore without definite explanation for their symptoms nor proposition for management. 7,8 This