title: Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry.
abstract: High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤ 2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.
authors.affiliation: iDigest: Zürich Center for Reflux and Swallowing Disorders, Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.|NIHR Nottingham Digestive Disease Biomedical Research Centre, Nottingham University Hospital.
authors.forename: M R
authors.initials: MR
authors.lastname: Fox
authors.affiliation: Department of Gastroenterology, Northwestern University School of Medicine, Chicago, Illinois, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Pandolfino
authors.affiliation: Esophageal Laboratory, Guys and St. Thomas NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sweis
authors.affiliation: iDigest: Zürich Center for Reflux and Swallowing Disorders, Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Sauter
authors.affiliation: Clínica de Fisiología Digestiva, Hospital Ángeles del Pedregal, Mexico City, Mexico.
authors.forename: A T
authors.initials: AT
authors.lastname: Abreu Y Abreu
authors.affiliation: Esophageal Laboratory, Guys and St. Thomas NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Anggiansah
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Bogte
authors.affiliation: Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Bredenoord
authors.affiliation: Legato Medical Systems, Inc., Rocky Mount, North Carolina, USA.
authors.forename: W
authors.initials: W
authors.lastname: Dengler
authors.affiliation: Ospedale Maggiore Policlinic, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Elvevi
authors.affiliation: iDigest: Zürich Center for Reflux and Swallowing Disorders, Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Fruehauf
authors.affiliation: Department of Surgery, St. Antonius Hospital, Cologne, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Gellersen
authors.affiliation: Global Health Economics and Market Access, Johnson & Johnson, Cincinnati, Ohio, USA.
authors.forename: S
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authors.lastname: Ghosh
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Gyawali
authors.affiliation: iDigest: Zürich Center for Reflux and Swallowing Disorders, Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Heinrich
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
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authors.lastname: Hemmink
authors.affiliation: Wingate Institute, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Jafari
authors.affiliation: iDigest: Zürich Center for Reflux and Swallowing Disorders, Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Kaufman
authors.affiliation: Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Kessing
authors.affiliation: Department of Gastroenterology, Northwestern University School of Medicine, Chicago, Illinois, USA.
authors.forename: M
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authors.lastname: Kwiatek
authors.affiliation: Department of Gastroenterology, Northwestern University School of Medicine, Chicago, Illinois, USA.
authors.forename: B
authors.initials: B
authors.lastname: Lubomyr
authors.affiliation: Department of Pediatric Gastroenterology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: M
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authors.lastname: Banasiuk
authors.affiliation: Digestive Physiology, Hospices Civils de Lyon and Lyon University, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Mion
authors.affiliation: Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pérez-de-la-Serna
authors.affiliation: Medical Biological Research Institute, University of Veracruz, México DF, Mexico.
authors.forename: J M
authors.initials: JM
authors.lastname: Remes-Troche
authors.affiliation: Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Rohof
authors.affiliation: Digestive Physiology, Hospices Civils de Lyon and Lyon University, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roman
authors.affiliation: Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ruiz-de-León
authors.affiliation: University Clinics of Visceral Surgery and Medicine, Division of Gastroenterology, Bern University Hospital, Bern, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Tutuian
authors.affiliation: Department of Pediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: M
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authors.lastname: Uscinowicz
authors.affiliation: Departamento de Gastroenterología and motility Laboratory Salvador Zubirán, Instituto Nacional de Ciencias Médicas y Nutrición, México DF, Mexico.
authors.forename: M A
authors.initials: MA
authors.lastname: Valdovinos
authors.affiliation: Sect Gastroenterology & Ege Reflux Study Group, Ege University School of Medicine, Izmir, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Vardar
authors.affiliation: Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Velosa
authors.affiliation: Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: D
authors.initials: D
authors.lastname: Waśko-Czopnik
authors.affiliation: Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Weijenborg
authors.affiliation: Department of Surgery, University of Rochester, Rochester, New York, USA.
authors.forename: C
authors.initials: C
authors.lastname: Wilshire
authors.affiliation: Division of Gastroenterology, University Hospital, Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wright
authors.affiliation: Gastroenterology and Hepatology Department, CHU Bordeaux and Bordeaux Segalen University, Saint André Hospital, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Zerbib
authors.affiliation: Menne Biomed, Tübingen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Menne
mesh_terms: D000328:Adult; D032921:Consensus; D003679:Deglutition / Q000502:physiology; D004931:Esophageal Achalasia / Q000145:classification / Q000175:diagnosis; D015154:Esophageal Motility Disorders / Q000145:classification / Q000175:diagnosis*; D004947:Esophagus / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods / Q000592:standards*; D008365:Manometry / Q000379:methods / Q000592:standards*; D015588:Observer Variation; D010528:Peristalsis / Q000502:physiology; D011446:Prospective Studies; D016037:Single-Blind Method
keywords: esophageal motility disorder; high-resolution manometry; inter-observer agreement