ArticleAlimentary pharmacology & therapeutics2022
Chicago classification v4.0 protocol improves specificity and accuracy of diagnosis of oesophagogastric junction outflow obstruction.
Article in Alimentary pharmacology & therapeutics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility.United European gastroenterology journal · 2025Guideline
- Gastro-esophageal diagnostic workup before bariatric surgery or endoscopic treatment for obesity: position statement of the International Society of Diseases of the Esophagus.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2024Guideline
- High-Resolution Manometry in Treated Achalasia: Scoping Review and Novel Nomenclature.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Article
- MULTICHANNEL INTRALUMINAL IMPEDANCE MAY BE USEFUL TO IDENTIFY CLINICALLY RELEVANT ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION.Arquivos de gastroenterologia · 2026Article
- Emerging innovation, artificial intelligence, and digital technology in esophagology.Annals of the New York Academy of Sciences · 2025Review
- The conundrum of esophagogastric junction outflow obstruction: Answers to key clinical questions.Annals of the New York Academy of Sciences · 2025Review
- Exploration of Diagnostic Value of Chicago Classification Version 4.0: Focusing on Rapid Drink Challenge.Journal of neurogastroenterology and motility · 2024Article
- Esophageal anatomy and physiology vary across spastic and non-spastic phenotypes of disorders of esophagogastric junction outflow.Neurogastroenterology and motility · 2024Article
- A Comparison between Chicago Classification Versions 3.0 and 4.0 and Their Impact on Manometric Diagnoses in Esophageal High-Resolution Manometry Cases.Diagnostics (Basel, Switzerland) · 2024Article
- Optimal Assessment, Treatment, and Monitoring of Adults with Eosinophilic Esophagitis: Strategies to Improve Outcomes.ImmunoTargets and therapy · 2024Review
- Look above the IRP: predicting abnormal confirmatory testing in patients with esophagogastric junction outflow obstruction.Therapeutic advances in gastroenterology · 2024Article
- Esophageal dysmotility in patients with eosinophilic esophagitis: pathogenesis, assessment tools, manometric characteristics, and clinical implications.Esophagus : official journal of the Japan Esophageal Society · 2023Review
- Editorial: reducing false alarms with oesophagogastric junction outflow obstruction.Alimentary pharmacology & therapeutics · 2022Article
- Chicago classification v4.0 protocol improves specificity and accuracy of diagnosis of oesophagogastric junction outflow obstruction.Alimentary pharmacology & therapeutics · 2022Article
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14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChicago classification version 4.0 (CCv4.0) introduced stringent diagnostic criteria for oesophagogastric junction outflow obstruction (EGJOO), in order to increase the clinical relevance of the diagnosis, although this has not yet been demonstrated.
aimsTo determine the prevalence of EGJOO using CCv4.0 criteria in patients with CCv3.0-based EGJOO, and to assess if provocative manoeuvres can predict a conclusive CCv4.0 diagnosis of EGJOO.
methodsClinical presentation, high resolution manometry (HRM) with rapid drink challenge (RDC), and timed barium oesophagogram (TBE) data were extracted for patients diagnosed with EGJOO as per CCv3.0 between 2018 and 2020. Patients were then re-classified according to CCv4.0 criteria, using clinically relevant symptoms (dysphagia and/or chest pain), and abnormal barium emptying at 5 min on TBE. Receiver operating characteristic (ROC) analyses identified HRM predictors of EGJOO.
resultsOf 2010 HRM studies, 144 (7.2%) fulfilled CCv3.0 criteria for EGJOO (median age 61 years, 56.9% female). Upon applying CCv4.0 criteria, EGJOO prevalence decreased to 1.2%. On ROC analysis, integrated relaxation pressure during RDC (RDC-IRP) was a significant predictor of a conclusive EGJOO diagnosis by CCv4.0 criteria (area under the curve: 96.1%). The optimal RDC-IRP threshold of 16.7 mm Hg had 87% sensitivity, 97.1% specificity, 95.7% negative predictive value and 91.3% positive predictive value for a conclusive EGJOO diagnosis; lower thresholds (10 mmHg, 12 mmHg) had better sensitivity but lower specificity.
conclusionCCv4.0 criteria reduced the prevalence of EGJOO by 80%, thereby refining the diagnosis and identifying clinically relevant outflow obstruction. Elevated RDC-IRP can predict conclusive EGJOO per CCv4.0.
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