Chicago Classification v4.0
Enter the metrics from the supine series of 10 wet swallows. Definitions: failed DCI below 100 mmHg·s·cm; weak DCI 100 to 450; fragmented a break of more than 5 cm with DCI above 450; premature distal latency below 4.5 s; hypercontractile DCI above 8,000. A conclusive diagnosis of most disorders also needs compatible symptoms and, for some, supportive tests.
Enter the values above.
Disorders
- Achalasia type I: raised IRP, 100% failed peristalsis.
- Achalasia type II: raised IRP, 100% failed peristalsis, panoesophageal pressurisation in 20% or more.
- Achalasia type III: raised IRP, no normal peristalsis, premature (spastic) contractions in 20% or more.
- EGJ outflow obstruction: raised supine and upright IRP, not meeting achalasia criteria, with symptoms and a supportive test.
- Absent contractility: normal IRP, 100% failed peristalsis.
- Distal oesophageal spasm: premature contractions in 20% or more, with symptoms.
- Hypercontractile oesophagus: hypercontractile swallows in 20% or more, with symptoms.
- Ineffective oesophageal motility: more than 70% ineffective swallows, or 50% or more failed.
Reference
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil. 2021;33(1):e14058.