Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil.
Adv Ther. 2021 May;38(5):2017-2026. doi: 10.1007/s12325-021-01714-w. Epub 2021 Mar 27.
The Chicago Classification is the most used classification for primary esophageal motility disorders (PEMD). This classification was recently updated to the 4.0 version. This opinion piece focuses on the possible implications for the treatment of PMED determined by the new classification. Chicago Classification 4.0 included two new concepts for the diagnosis of achalasia: (1) type III achalasia diagnosis demands 100% absent peristalsis defined as either failed peristalsis or spasm; (2) "inconclusive diagnosis of achalasia" was added as a possibility. Both may decrease unnecessary treatment. Esophagogastric junction outflow obstruction, distal esophageal spasm, and hypercontractile esophagus were only considered clinically significant when correlated to supportive testing and relevant clinical symptoms and in the absence of gastroesophageal reflux disease. This may decrease the surge of treatment, especially peroral endoscopic myotomy, based solely on manometric diagnosis.
芝加哥分类法是用于原发性食管动力障碍（PEMD）的最常用分类法。该分类法最近更新到了 4.0 版本。本文观点集中于新分类法对 PEMD 治疗的可能影响。芝加哥分类法 4.0 为贲门失弛缓症的诊断纳入了两个新概念：（1）Ⅲ型贲门失弛缓症的诊断要求 100%无蠕动，定义为蠕动缺失或痉挛；（2）“贲门失弛缓症不确定诊断”作为一种可能性被加入。这两者都可能减少不必要的治疗。胃食管交界处流出梗阻、远端食管痉挛和高收缩性食管只有在与支持性检查以及相关临床症状相关联且不存在胃食管反流病时才被认为具有临床意义。这可能会减少治疗，尤其是经口内镜肌切开术，仅仅基于测压诊断的情况。
