Noh Jin Hee, Jung Kee Wook, Yoon In Ja, Na Hee Kyong, Ahn Ji Yong, Lee Jeong Hoon, Kim Do Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Jung Hwoon-Yong
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Neurogastroenterol Motil. 2023 Jul 30;29(3):326-334. doi: 10.5056/jnm22121.
BACKGROUND/AIMS: We aim to investigate the diagnostic accuracy and differences between Chicago classification version 3.0 (CC v3.0) and 4.0 (CC v4.0).
Patients who underwent high-resolution esophageal manometry (HRM) for suspected esophageal motility disorders were prospectively recruited between May 2020 and February 2021. The protocol of HRM studies included additional positional change and provocative testing designed by CC v4.0.
Two hundred forty-four patients were included. The median age was 59 (interquartile range, 45-66) years, and 46.7% were males. Of these, 53.3% (n = 130) and 61.9% (n = 151) were categorized as normalcy by CC v3.0 and CC v4.0, respectively. The 15 patients diagnosed of esophagogastric junction outflow obstruction (EGJOO) by CC v3.0 was changed to normalcy by position (n = 2) and symptom (n = 13) by CC v4.0. In seven patients, the ineffective esophageal motility (IEM) diagnosis by CC v3.0 was changed to normalcy by CC v4.0. The diagnostic rate of achalasia increased from 11.1% (n = 27) to 13.9% (n = 34) by CC v4.0. Of patients diagnosed IEM by CC v3.0, 4 was changed to achalasia based on the functional lumen imaging probe (FLIP) results by CC v4.0. Three patients (2 with absent contractility and 1 with IEM in CC v3.0) were newly diagnosed with achalasia using a provocative test and barium esophagography by CC v4.0.
CC v4.0 is more rigorous than CC v3.0 for the diagnosis of EGJOO and IEM and diagnoses achalasia more accurately by using provocative tests and FLIP. Further studies on the treatment outcomes following diagnosis with CC v4.0 are needed.
背景/目的：我们旨在研究芝加哥分类第3.0版（CC v3.0）和第4.0版（CC v4.0）之间的诊断准确性及差异。
在2020年5月至2021年2月期间，前瞻性招募因疑似食管动力障碍而接受高分辨率食管测压（HRM）的患者。HRM研究方案包括CC v4.0设计的额外体位改变和激发试验。
纳入244例患者。中位年龄为59岁（四分位间距，45 - 66岁），男性占46.7%。其中，分别有53.3%（n = 130）和61.9%（n = 151）被CC v3.0和CC v4.0分类为正常。CC v3.0诊断为食管胃交界部流出道梗阻（EGJOO）的15例患者，根据CC v4.0的体位（n = 2）和症状（n = 13）改变为正常。7例患者中，CC v3.0诊断的无效食管动力（IEM）被CC v4.0改为正常。CC v4.0使贲门失弛缓症的诊断率从11.1%（n = 27）提高到13.9%（n = 34）。在CC v3.0诊断为IEM的患者中，4例根据CC v4.0的功能性管腔成像探头（FLIP）结果改为贲门失弛缓症。3例患者（2例在CC v3.0中无收缩功能，1例在CC v3.0中为IEM）通过CC v4.0的激发试验和食管钡餐造影新诊断为贲门失弛缓症。
CC v4.0在诊断EGJOO和IEM方面比CC v3.0更严格，通过激发试验和FLIP能更准确地诊断贲门失弛缓症。需要进一步研究CC v4.0诊断后的治疗结果。
