Journal
ADVANCES IN THERAPY
Volume 38, Issue 5, Pages 2017-2026Publisher
SPRINGER
DOI: 10.1007/s12325-021-01714-w
Keywords
Achalasia; Chicago classification; Esophageal manometry; Esophageal motility disorders; High-resolution manometry; Peroral endoscopic myotomy
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The Chicago Classification 4.0 introduces new concepts for the diagnosis of achalasia, potentially reducing unnecessary treatment. Conditions such as esophagogastric junction outflow obstruction, distal esophageal spasm, and hypercontractile esophagus are now considered clinically significant only in certain conditions, leading to a potential decrease in treatment, especially peroral endoscopic myotomy, solely based on manometric diagnosis.
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.
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