Wang Hoyoung, Jung Kee Wook, Noh Jin Hee, Na Hee Kyoung, Ahn Ji Yong, Lee Jeong Hoon, Kim Do Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Jung Hwoon-Yong
Department of Gastroenterology, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Neurogastroenterol Motil. 2024 Oct 30;30(4):453-458. doi: 10.5056/jnm23149.
BACKGROUND/AIMS: Chicago classification version 4.0 enhances the diagnosis of esophageal motility disorders using position change and provocative tests such as multiple rapid swallows and a rapid drink challenge. This study investigates the diagnostic role of the rapid drink challenge based on Chicago classification 4.0 using a functional luminal imaging probe to estimate the cutoff value.
This study included 570 patients who underwent esophageal manometry with a rapid drink challenge between January 2019 and October 2022. The diagnostic flow was analyzed according to Chicago classification 4.0.
Ninety-nine patients (38, achalasia; 11, esophagogastric junction outflow obstruction; 7, ineffective esophageal motility; 1, hypercontractile esophagus; and 42, normal esophageal function) failed the rapid drink challenge. Among the 453 participants, 50 and 86 were diagnosed with achalasia and esophagogastric junction outflow obstruction, respectively, using Chicago classification 4.0. In 249/453 (55.0%) patients initially diagnosed with esophagogastric junction outflow obstruction using Chicago classification 3.0, the diagnosis was changed to achalasia (n = 28), hypercontractile esophagus (n = 7), ineffective esophageal motility (n = 7), or normal esophageal function (n = 121) using Chicago classification 4.0. Rapid drink challenge-integrated relaxation pressure's diagnostic cutoff value was 19 mmHg. Nine patients had diagnoses changed after the rapid drink challenge, including 3 with panesophageal pressurization.
Chicago classification 4.0 increased the diagnostic yield of the rapid drink challenge by 2.0% (9/453 patients). However, the rapid drink challenge had a failure rate of 17.9% (99/552 patients). Given the relatively low diagnostic yield and high failure rate of the rapid drink challenge, we recommend adopting an individualized approach to manometry.
背景/目的：芝加哥分类第4.0版通过体位改变和激发试验（如多次快速吞咽和快速饮水试验）改进了食管动力障碍的诊断。本研究使用功能性管腔成像探头评估临界值，探讨基于芝加哥分类第4.0版的快速饮水试验的诊断作用。
本研究纳入了2019年1月至2022年10月期间接受食管测压并进行快速饮水试验的570例患者。根据芝加哥分类第4.0版分析诊断流程。
99例患者（38例贲门失弛缓症；11例食管胃交界部流出道梗阻；7例食管动力无效；1例食管高收缩；42例食管功能正常）快速饮水试验未通过。在453名参与者中，根据芝加哥分类第4.0版，分别有50例和86例被诊断为贲门失弛缓症和食管胃交界部流出道梗阻。在最初根据芝加哥分类第3.0版诊断为食管胃交界部流出道梗阻的249/453（55.0%）例患者中，根据芝加哥分类第4.0版，诊断改为贲门失弛缓症（n = 28）、食管高收缩（n = 7）、食管动力无效（n = 7）或食管功能正常（n = 121）。快速饮水试验整合松弛压的诊断临界值为19 mmHg。9例患者在快速饮水试验后诊断发生改变，其中3例为全食管加压。
芝加哥分类第4.0版使快速饮水试验的诊断率提高了2.0%（9/453例患者）。然而，快速饮水试验的失败率为17.9%（99/552例患者）。鉴于快速饮水试验的诊断率相对较低且失败率较高，我们建议采用个体化的测压方法。
