Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, MI, USA.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
Neurogastroenterol Motil. 2021 Jun;33(6):e14115. doi: 10.1111/nmo.14115. Epub 2021 Mar 17.
Hypercontractile esophagus (HE), defined by the Chicago Classification version 3.0 (CCv3.0) as 20% or more hypercontractile peristalsis (Distal Contractile Integral >8000 mmHg·s·cm) on high-resolution manometry (HRM), is a heterogeneous disorder with variable clinical presentations and natural course, leading to management challenges. An update on the diagnostic criteria for clinically relevant HE was needed. Literature on HE was extensively reviewed by the HE subgroup of the Chicago Classification version 4.0 (CCv4.0) Working Group and statements relating to the diagnosis of HE were ranked according to the RAND UCLA Appropriateness methodology by the Working Group, and the quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. An overall emphasis of the CCv4.0 is on clinically relevant esophageal dysmotility, and thus it is recommended that an HE diagnosis requires both conclusive manometric diagnosis and clinically relevant symptoms of dysphagia and non-cardiac chest pain. The Working Group also recognized the subtypes of HE, including single-peaked, multi-peaked contractions (Jackhammer esophagus), and hypercontractile lower esophageal sphincter. However, there are no compelling data currently for formally subdividing HE to these subgroups in clinical practice.
高收缩性食管（HE），根据芝加哥分类第 3.0 版（CCv3.0）定义为高分辨率测压（HRM）上 20%或更多的高收缩性蠕动（远端收缩积分>8000mmHg·s·cm），是一种具有不同临床表现和自然病程的异质性疾病，导致管理挑战。需要更新临床相关 HE 的诊断标准。CCv4.0 的 HE 分组对 HE 的文献进行了广泛审查，并且根据 RAND UCLA 适宜性方法对与 HE 诊断相关的陈述进行了分级，使用推荐评估、制定和评估（GRADE）框架对证据质量进行了评级。CCv4.0 的总体重点是临床相关的食管动力障碍，因此建议 HE 的诊断需要有明确的测压诊断和吞咽困难和非心源性胸痛的临床相关症状。工作组还认识到 HE 的亚型，包括单峰、多峰收缩（痉挛性食管）和高收缩性下食管括约肌。然而，目前尚无令人信服的证据支持在临床实践中将 HE 正式细分为这些亚组。
