n South African Gastroenterology Review - The Chicago Classification "simplified" : review

Volume 13, Issue 2
  • ISSN : 1812-1659



The aim of his article is to provide insight to the interpretation of the "mystery tracings" of High Resolution Manometry Pressure Topography (HRMPT) as it is currently applied to esophageal motility disorders. Esophageal motility disorders are classified by the Chicago Classification using HRMPT and standardized metrics. This classification is the result of recurring deliberations of the Pharyngeal and Esophageal motility disorders and the Gastro-Esophageal reflux disease steering committees of the International Working Group for Gastrointestinal Motility and Function. This is an umbrella organization for academics and clinicians with an active interest in the clinical application of these technologies. They have modified the classification in 2009 in San Diego, 2011 in Ascona, and 2014 in Chicago. In future they plan to update the classification on a three-year cycle. HRM interpretation is facilitated by esophageal pressure topography plots, known as Clouse plots in honor of Ray E. Clouse (1951-2007), their key innovator. The HRM concepts were developed in the late 1980's. The first clinical water perfused HRM system studies were introduced in the mid 1990's and the first solid-state studies in 2002-2003. The first major version of the Chicago Classification was published in 2009 after a meeting of the International HRM working group. Their aim was to standardize HRM metrics and thereby categorize the esophageal motility disorders in patients with non-obstructive dysphagia and/or chest pain. The Chicago Classification is applied to results analyzing each individual swallow using HRM pressure topography and the protocol of giving ten 5 ml boluses of water to the patient in a supine position with 20-30 seconds between each swallow. The Chicago Classification was determined using the Sierra system. Cutoffs defining abnormal metrics, especially IRP, are technology-specific.

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