ReviewNeurogastroenterology and motility2021
Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0
Erratum issued 4 registry-linked trialsOpen access · bronzeAbstract readReview
In one paragraph
Review in Neurogastroenterology and motility, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 4 registered trials, which are not on this map. Cited by 512 papers, 7 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
512citing papers in PubMed, 7 pooled it
70.6field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Defining High-Resolution Manometry Thresholds of Backward Pressure Across the Lower Esophageal Sphincter Through Straight Leg Raise Maneuver Predictive of Pathologic Acid Exposure Time
NCT06588348 early_phase1active not recruitingnot on this mapstarted 2022, after this paper: background citation
Corticosteroid Effect on Achalasia Variant Esophagogastric Junction Outflow Obstruction
Evolution of the Chicago Classification: Bridging Physiology and Mechanics
PRospective Registry of Esophageal Motility
Who cites it
512 citing papers in PubMed, 7 syntheses or guidelines pooled it, 970 citations in OpenAlex.
- Dietary management and feeding considerations of pediatric aerodigestive and upper gastrointestinal motility disorders.Journal of pediatric gastroenterology and nutrition · 2026Guideline
- SAGES-EAES systematic review and meta-analysis for the use of FLIP/impedance planimetry in the surgical work-up and management of GERD, achalasia, and gastroparesis.Surgical endoscopy · 2026Pooled it
- SAGES-EAES clinical practice guidelines for the use of FLIP/impedance planimetry in the surgical work-up and management of GERD, achalasia, and gastroparesis.Surgical endoscopy · 2026Guideline
- AI in Esophageal Motility Disorders: Systematic Review of High-Resolution Manometry Studies.Journal of medical Internet research · 2025Pooled it
- Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility.United European gastroenterology journal · 2025Guideline
- European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management.United European gastroenterology journal · 2025Guideline
- Robotic versus laparoscopic heller myotomy for esophageal achalasia: an updated systematic review and meta-analysis.Langenbeck's archives of surgery · 2025Pooled it
- Efficacy and safety of acotiamide in esophagogastric junction outflow obstruction: a placebo-controlled phase II trial.Esophagus : official journal of the Japan Esophageal Society · 2026Trial
- Food passageway-related sequelae in the RefluxStop prospective multicenter trial: patient-centric outcomes of dysphagia, odynophagia, gas-bloating, and inability to belch and/or vomit at 5 years.Surgical endoscopy · 2025Trial
- Esophageal peristalsis in health and disease: mechanistic insights.Physiological reviews · 2026Review
- Biomechanical Assessment During High-Resolution Impedance Manometry Enhances Characterization of Inconclusive Esophagogastric Junction Outflow Obstruction.Neurogastroenterology and motility · 2026Article
- Rome V Criteria for Adults: What's New and Why?United European gastroenterology journal · 2026Review
- Corkscrew esophagus due to type-3 achalasia: A rare combination.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026Article
- Role of prehabilitative gastrostomy tube feeding to bridge severely malnourished surgically unfit achalasia patients to per-oral endoscopic myotomy.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026Article
- Recent advances in managing esophageal epiphrenic diverticula: a review of the impact of endoscopy, high-resolution manometry, and POEM.Clinical journal of gastroenterology · 2026Review
- What is new in Rome V?: Redefining diagnostic criteria and clinical pathways in disorders of gut-brain interaction.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026Review
- Discordance Between Functional Lumen Imaging Probe and Timed Barium Esophagram in Patients With a Chicago Classification v4.0 Manometric Diagnosis of Esophagogastric Junction Outflow Obstruction.Neurogastroenterology and motility · 2026Article
- Unravelling the Links Between Gastroesophageal Reflux and Lung Disease: New Insights.Digestive diseases and sciences · 2026Review
- Gastroesophageal reflux disease (GERD)-associated chronic cough: long-term outcomes and predictors of response to anti-reflux surgery.Surgical endoscopy · 2026Article
- Definition of Clinically Meaningful Thresholds for the Brief Esophageal Dysphagia Questionnaire and Eckardt Score: A Multicenter Psychometric Study.Neurogastroenterology and motility · 2026Article
452 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Erratum issuedErratum.2024
Authors and funding
52 authors at 20 institutions in 21 countries.
Rena YadlapatiCenter for Esophageal Diseases, Division of Gastroenterology & Hepatology, University of California San Diego, La Jolla, CA, USA.ORCID 0000-0002-7872-2033
Peter J KahrilasDivision of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Mark R FoxDivision of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland.ORCID 0000-0003-4394-5584
Albert J BredenoordDepartment of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
C Prakash GyawaliDivision of Gastroenterology & Hepatology, Washington University School of Medicine, St. Louis, MO, USA.ORCID 0000-0002-3388-0660
Sabine RomanDigestive Physiology, Hospices Civils de Lyon, Université Lyon I, Univ Lyon, Lyon, France.ORCID 0000-0002-7798-7638
Arash BabaeiNational Jewish Health, Denver, Co, USA.ORCID 0000-0001-6790-2402
Ravinder K MittalCenter for Esophageal Diseases, Division of Gastroenterology & Hepatology, University of California San Diego, La Jolla, CA, USA.ORCID 0000-0001-5228-9617
Nathalie RommelDepartment of Gastroenterology, Neurosciences, Experimental ORL, Neurogastroenterology & Motility, Deglutology - University Hospitals Leuven, University of Leuven, Leuven, Belgium.
Edoardo SavarinoDepartment of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
Daniel SifrimWingate institute of Neurogastroenterology, Queen Mary University of London, London, UK.ORCID 0000-0002-4894-0523
André SmoutDepartment of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands.ORCID 0000-0001-7796-6282
Michael F VaeziVanderbilt University Medical Center, Nashville, TN, USA.
Frank ZerbibCHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, INSERM CIC 1401, Université de Bordeaux, Bordeaux, France.ORCID 0000-0002-6802-2121
Junichi AkiyamaNational Center for Global Health and Medicine, Tokyo, Japan.
Shobna BhatiaSir HN Reliance Foundation Hospital, Mumbai, India.
Serhat BorDiv. Gastroenterology, Ege University School of Medicine, Izmir, Turkey.ORCID 0000-0001-5766-9598
Dustin A CarlsonDivision of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.ORCID 0000-0002-1702-7758
Joan W ChenUniversity of Michigan, Ann Arbor, MI, USA.
Daniel CisternasClínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo. Santiago, Chile.ORCID 0000-0003-0909-5192
Charles CockFlinders University, Adelaide, SA, Australia.ORCID 0000-0003-3578-1137
Enrique Coss-AdameGastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Ciudad de México, CDMX, Mexico.
Nicola de BortoliDepartment of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.ORCID 0000-0003-1995-1060
Claudia DefilippiUniversity Hospital, University of Chile, Santiago, Chile.
Ronnie FassMetroHealth System and case Western Reserve University, Cleveland, OH, USA.ORCID 0000-0002-4807-3052
Uday C GhoshalDepartment of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.ORCID 0000-0003-0221-8495
Sutep GonlachanvitExcellence Center on Neurogastroenterology and Motility, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Albis HaniPontificia Universidad Javeriana-Hospital San Ignacio, Bogota, Colombia.
Geoffrey S HebbardRoyal Melbourne Hospital, University of Melbourne, Parkville, Vic, Australia.
Kee Wook JungDepartment of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.ORCID 0000-0002-3771-3691
Philip KatzWeill Cornell Medicine, New York, NY, USA.
David A KatzkaMayo Clinic, Rochester, MN, USA.
Abraham KhanLangone Health, New York University, New York, NY, USA.ORCID 0000-0002-8683-2320
Geoffrey Paul KohnMonash University, Melbourne, Vic, Australia.
Adriana LazarescuUniversity of Alberta, Edmonton, AB, Canada.
Johannes LenglinerUniversity of Bern, Bern, Switzerland.
Sumeet K MittalNorton Thoracic Institute, Phoenix, AZ, USA.
Taher OmariCollege of Medicine & Public Health, Flinders University, Adelaide, SA, Australia.ORCID 0000-0001-5108-7378
Moo In ParkDepartment of Internal Medicine, Kosin University College of Medicine, Busan, Korea.ORCID 0000-0003-2071-6957
Roberto PenaginiGastroenterology Unit, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.ORCID 0000-0001-6918-9479
Daniel PohlDivision of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Joel E RichterUniversity of South Florida Morsani College of Medicine, Tampa, Florida, USA.
Jordi SerraCIBERehd, University Hospital Germans Trias i Pujol, Badalona, Spain.ORCID 0000-0003-2120-6270
Rami SweisUniversity College London Hospital, London, UK.
Jan TackTARGID, University of Leuven, Leuven, Belgium.
Roger P TatumDepartment of Surgery/VA Puget Sound HCS, University of Washington, Seattle, WA, USA.
Radu TutuianBürgerspital Solothurn, University of Bern, Bern, Switzerland.
Marcelo F VelaMayo Clinic Arizona, Scottsdale, Arizona, USA.
Reuben K WongYong Loo Lin of Medicine, National University of Singapore, Singapore, Singapore.
Justin C WuThe Chinese University of Hong Kong, Hong Kong SAR.
Yinglian XiaoDepartment of Gastroenterology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
John E PandolfinoDivision of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Northwestern University · USAmsterdam University Medical Centers · NLFlinders University · AUKU Leuven · BEMayo Clinic in Arizona · USUniversity of Bern · CHUniversity of California San Diego · USChinese University of Hong Kong · HKChulalongkorn University · THCornell University · USEge University · TRHospital Universitari Germans Trias i Pujol · ESInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán · MXKosin University · KRMetroHealth Medical Center · USMonash University · AUNational Center for Global Health and Medicine · JPNational Jewish Health · USNational University of Singapore · SGNYU Langone Health · US
Funding
Role of altered response to volumetric distension in esophageal diseaseP01DK117824 · NIDDK · NORTHWESTERN UNIVERSITY AT CHICAGO · PI PANDOLFINO, JOHN E · 2018 to 2022
$7.3MTargeting Hypervigilance and Autonomic Arousal: the Psycho-physiologic Model of GERDR01DK092217 · NIDDK · NORTHWESTERN UNIVERSITY AT CHICAGO · PI JOHN E PANDOLFINO · 2012 to 2026
$5.0MNIDDK NIH HHS P01 DK092217NIDDK NIH HHS P01 DK117824NIDDK NIH HHS R01 DK092217
Abstract
Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.
Indexed as
Esophageal AchalasiaEsophageal Motility DisordersEsophageal Spasm, DiffuseEsophagogastric JunctionHumansManometryachalasiaesophageal spasmintegrated relaxation pressurelower esophageal sphincterperoral endoscopic myotomy
Identifiers
What OpenQuestion holds
Textmetadata
LicenceTDM
Read underepoch 390
Registered trials
NCT04813029ClinicalTrials.gov
NCT06588348ClinicalTrials.gov
NCT06883175ClinicalTrials.gov
NCT07506746ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.