Chicago Classification Update (version 4.0): Main Statements Review

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OBJECTIVE

To analyze and discuss the main statements of the updated Chicago Classification version 4 of esophageal motility disorders, published in 2021 in the journal Neurogastroenterology and Motility.

MAIN STATEMENTS

The Chicago Classification version 4.0 is an updated classification for esophageal motility disorders using high-resolution manometry (HMR). Over the course of two years, seven expert groups (a total of 52 esophageal manometry specialists from different countries) worked on creating a new classification. Key updates to the Chicago Classification version 4.0 include the development of a detailed and enlarged research methodology as well as the utilization of provocative tests. Unlike the previous version, the Chicago Classification’s current version implies a mandatory description of the initial manometric parameters of the esophagogastric junction (EGJ). In addition, updates and more stringent criteria have been introduced in the diagnosis of esophageal-gastric junction disorders and ineffective esophageal motility. Depending on the presence and severity of clinical symptoms and the results of provocative tests, the new version of the Chicago Classification (version 4.0) allows the issuance of a conclusion after esophageal manometry, both in the form of a final and an unconfirmed manometric diagnosis.

CONCLUSIONS

The main provisions of the Chicago Classification of Esophageal Motility Disorders, Revision 4, generally confirm the previous version of this document. The latest version underwent revisions made by the expert panel, including the expanded use of provocative tests to enable a more precise diagnosis of LES obstruction. New diagnostic criteria have been proposed to standardize the diagnosis of esophageal motility disorders.

Keywords:

esophageal manometry

achalasia

ineffective esophageal motility

esophagospasm

esophageal motility disorders

Authors:

Kaibysheva V.O.

Pirogov Russian National Research Medical University of the Russian Ministry of Health

ORCID: 0000-0003-0114-3700

Kiriltseva M.M.

Pavlov First Saint Petersburg State Medical University

Smirnov A.A.

National Medical Research Center for Therapy and Preventive Medicine

ORCID: 0000-0002-6061-2565

Fedorov E.D.

Pirogov Russian National Research Medical University of the Russian Ministry of Health

SPIN RSCI: 6785-9959
Scopus AuthorID: 7004381289
ORCID: 0000-0002-6036-7061

Shapovolyants S.G.

Pirogov Russian National Research Medical University

Received:

20.11.2022

Accepted:

07.01.2023

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