title: Comparison of motor diagnoses by Chicago Classification versions 2.0 and 3.0 on esophageal high-resolution manometry.
abstract: BACKGROUND
  The Chicago Classification (CC) uses high-resolution manometry (HRM) software tools to designate esophageal motor diagnoses. We evaluated changes in diagnostic designations between two CC versions, and determined motor patterns not identified by either version.
  
  
  METHODS
  In this observational cohort study of consecutive patients undergoing esophageal HRM over a 6-year period, proportions meeting CC 2.0 and 3.0 criteria were segregated into esophageal outflow obstruction, hypermotility, and hypomotility disorders. Contraction wave abnormalities (CWA), and 'normal' cohorts were recorded. Symptom burden was characterized using dominant symptom intensity and global symptom severity. Motor diagnoses, presenting symptoms, and symptom burden were compared between CC 2.0 and 3.0, and in cohorts not meeting CC diagnoses.
  
  
  RESULTS
  Of 2569 eligible studies, 49.9% met CC 2.0 criteria, but only 40.3% met CC 3.0 criteria (P<.0001). Between CC 2.0 and 3.0, 82.8% of diagnoses were concordant. Discordance resulted from decreasing proportions of hypermotility (4.4%) and hypomotility (9.0%) disorders, and increase in 'normal' designations (13.0%); esophageal outflow obstruction showed the least variation between CC versions. Symptom burden was higher with CC 3.0 diagnoses (P≤.005) but not with CC 2.0 diagnoses (P≥.1). Within 'normal' cohorts for both CC versions, CWA were associated with higher likelihood of esophageal symptoms, especially dysphagia, regurgitation, and heartburn, compared to truly normal studies (P≤.02 for each comparison).
  
  
  CONCLUSIONS
  Despite lower sensitivity, CC 3.0 identifies esophageal motor disorders with higher symptom burden compared to CC 2.0. CWA, which are associated with both transit and perceptive symptoms, are not well identified by either version.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.|Division of Gastroenterology, Duke University School of Medicine and Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: A
authors.identifier: http://orcid.org/0000-0001-7214-5901
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.|Division of Gastroenterology, University of Colorado, Denver, CO, USA.
authors.forename: B
authors.initials: B
authors.lastname: Cassell
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.
authors.forename: N
authors.initials: N
authors.lastname: Sainani
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.|Gastroenterology Department, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: D
authors.initials: D
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.
authors.forename: B
authors.initials: B
authors.lastname: Shahid
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.
authors.forename: M
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.
authors.forename: F A
authors.initials: FA
authors.lastname: Mirza
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.
authors.forename: S
authors.initials: S
authors.lastname: Munigala
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.
authors.forename: C P
authors.identifier: http://orcid.org/0000-0002-3388-0660
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D015331:Cohort Studies; D015154:Esophageal Motility Disorders / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000145:classification* / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Chicago classification; contraction wave abnormalities; high-resolution manometry