食管动力评估和芝加哥分类版本 4.0 的启示。
Evaluation of Esophageal Motility and Lessons from Chicago Classification version 4.0.
机构信息
Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
Division of Gastroenterology, University of California, San Diego, ACTRI, Building 1W517, 9500 Gilman Drive MC 0956, La Jolla, CA, 92093, USA.
出版信息
Curr Gastroenterol Rep. 2022 Jan;24(1):10-17. doi: 10.1007/s11894-022-00836-7.
PURPOSE OF REVIEW
Chicago Classification has standardized clinical approach to primary esophageal motility disorders. With new clinical data and advancing treatments, Chicago Classification has undergone multiple revisions to reflect updated findings and enhance diagnostic accuracy. This review will describe the recently published Chicago Classification version 4.0 (CCv4.0), which aimed to enhance diagnostic characterization and limit overdiagnosis of inconclusive esophageal motility diagnoses.
RECENT FINDINGS
Key revisions outlined in CCv4.0 include (1) a modified standardized HRM study protocol performed in supine and upright positions, (2) recommended ancillary testing and manometric provocation for inconclusive manometric diagnoses (3) the required presence of obstructive symptoms for conclusive diagnoses of esophagogastric junction outflow obstruction, distal esophageal spasm and hypercontractile esophagus, and (4) requirement of confirmatory testing for esophagogastric junction outflow obstruction. These key modifications aim to improve diagnostic accuracy and consistency of clinically relevant esophageal motility disorders, and subsequently clinical outcomes.
目的综述
芝加哥分类法已经使原发性食管动力障碍的临床处理方法标准化。随着新的临床数据和治疗方法的发展，芝加哥分类法已经进行了多次修订，以反映更新的发现并提高诊断准确性。本综述将描述最近发布的芝加哥分类法第 4.0 版（CCv4.0），其旨在增强诊断特征并限制对不确定食管动力诊断的过度诊断。
最近的发现
CCv4.0 中概述的主要修订包括（1）改良的标准化 HRM 研究方案，在仰卧位和直立位进行，（2）推荐对不确定的测压诊断进行辅助测试和测压激发，（3）对于胃食管交界处流出梗阻、远端食管痉挛和高收缩性食管的明确诊断，需要存在阻塞症状，以及（4）对于胃食管交界处流出梗阻，需要进行确认性测试。这些关键的修改旨在提高临床相关食管动力障碍的诊断准确性和一致性，进而改善临床结果。
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