Kurin Michael, Adil Syed A, Damjanovska Sofi, Tanner Samuel, Greer Katarina
Division of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Department of General Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
J Neurogastroenterol Motil. 2023 Jan 30;29(1):38-48. doi: 10.5056/jnm21250.
BACKGROUND/AIMS: Chicago classification version 4.0 (CCv4.0) of esophageal motility disorders developed a more stringent diagnostic criteria for ineffective esophageal motility (IEM) than version 3.0. We studied the implications of the new diagnostic criteria on the prevalence of IEM, and clinically characterized and compared the population of patients who no longer meet diagnostic criteria for IEM to those who retain the diagnosis.
We included all consecutively performed high-resolution esophageal impedance manometries from 2014 to 2021. Three cohorts of patients with IEM were created: Patients with IEM by Chicago classification version 3.0 (CCv3.0; CC3 group), by CCv4.0 only (CC4 group), and by CCv3.0 who are now considered normal (Normal group). Demographics, manometric and reflux parameters, and clinical outcomes were compared.
A total of 594 manometries were analyzed. Of those, 66 (11.1%) met criteria for IEM by CCv3.0 (CC3), 41 (62.0%) retained an IEM diagnosis using CCv4.0 criteria (CC4), while 25 (38.0%) patients no longer met criteria for IEM (Normal). The CC4 group had higher esophageal acid exposure, especially supine (% time - 18.9% vs 2.2%; = 0.005), less adequate peristaltic reserve (22.0% vs 88.0%; = 0.003), and higher Demeester score (49.0 vs 21.2; = 0.017) compared to the Normal group. There was no difference in bolus clearance between the groups.
IEM under CCv4.0 has a stronger association with pathologic reflux, especially supine reflux, and inadequate peristaltic reserve, but impairment in bolus clearance is unchanged when compared with IEM diagnosed based on CCv3.0. Further studies are required to determine the implications of these findings on management strategies.
背景/目的：食管动力障碍的芝加哥分类第4.0版（CCv4.0）对无效食管动力（IEM）制定了比第3.0版更为严格的诊断标准。我们研究了新诊断标准对IEM患病率的影响，并对不再符合IEM诊断标准的患者群体与仍保留该诊断的患者群体进行了临床特征分析和比较。
我们纳入了2014年至2021年期间所有连续进行的高分辨率食管阻抗测压检查。创建了三组IEM患者队列：符合芝加哥分类第3.0版（CCv3.0；CC3组）的IEM患者、仅符合CCv4.0的IEM患者（CC4组）以及原本符合CCv3.0但现在被视为正常的患者（正常组）。比较了人口统计学、测压和反流参数以及临床结局。
共分析了594次测压检查。其中，66例（11.1%）符合CCv3.0的IEM标准（CC3），41例（62.0%）使用CCv4.0标准仍保留IEM诊断（CC4），而25例（38.0%）患者不再符合IEM标准（正常）。与正常组相比，CC4组食管酸暴露更高，尤其是仰卧位时（时间百分比 - 18.9%对2.2%；P = 0.005），蠕动储备不足更少（22.0%对88.0%；P = 0.003），以及Demeester评分更高（49.0对21.2；P = 0.017）。各组间食团清除率无差异。
CCv4.0下的IEM与病理性反流，尤其是仰卧位反流以及蠕动储备不足的关联更强，但与基于CCv3.0诊断的IEM相比，食团清除障碍并无变化。需要进一步研究以确定这些发现对管理策略的影响。
