The Chicago Classification of Esophageal Motility

Description

Esophageal motility can be described using the Chicago classification. The authors are from multiple institutions in Europe, North America, China and Australia.

Analysis: high resolution esophageal pressure topography

Parameters:

(1) integrated relaxation pressure (IRP)

(2) distal contractile integral (DCI) in mm Hg per second per cm

(3) distal latency (DL), the interval between the upper esophageal sphincter relaxation and the contractile deceleration point

(4) peristalsis

(5) peristaltic breaks in cm

Integrated Relaxation Pressure Above the Upper Limit of Normal

Peristalsis	Diagnosis
absent	achalasia (Types I, II or III)
intact or weak peristalsis	esophagogastric junction (EGJ) outflow obstruction

Integrated Relaxation Pressure Normal

Finding	Diagnosis
failed peristalsis in all swallows (100%)	absent peristalsis
failed peristalsis in > 30% and < 100%	frequent failed peristalsis
DCI > 8,000 mm Hg per second per cm in 1 or more swallows	hypercontractile (“jackhammer”) esophagus
mean DCI 5,001 to 8,000 mm Hg per second per cm	hypertensive (“nutcracker”) peristalsis
small or large breaks in the 20 mm Hg isobaric contour	weak peristalsis (with small or large peristaltic defects)
reduced distal latency, with >= 20% premature contractions	distal esophageal spasm (DES)
normal distal latency, with >= 20% of swallows showing rapid contractions	rapid contractions with normal latency

Normal motility indicates that all of the measures are within normal limits.

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The Chicago Classification of Esophageal Motility

Description

Specialty