Additional Diagnostic Yield of the Rapid Drink Challenge in Chicago Classification Version 4.0 Compared With Version 3.0.

IF 3.3 3区 医学 Q2 CLINICAL NEUROLOGY Journal of Neurogastroenterology and Motility Pub Date : 2024-10-30 DOI:10.5056/jnm23149
Hoyoung Wang, Kee Wook Jung, Jin Hee Noh, Hee Kyoung Na, Ji Yong Ahn, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
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Abstract

Background/aims: Chicago classification version 4.0 enhances the diagnosis of esophageal motility disorders using position change and provocative tests such as multiple rapid swallows and a rapid drink challenge. This study investigates the diagnostic role of the rapid drink challenge based on Chicago classification 4.0 using a functional luminal imaging probe to estimate the cutoff value.

Methods: This study included 570 patients who underwent esophageal manometry with a rapid drink challenge between January 2019 and October 2022. The diagnostic flow was analyzed according to Chicago classification 4.0.

Results: Ninety-nine patients (38, achalasia; 11, esophagogastric junction outflow obstruction; 7, ineffective esophageal motility; 1, hypercontractile esophagus; and 42, normal esophageal function) failed the rapid drink challenge. Among the 453 participants, 50 and 86 were diagnosed with achalasia and esophagogastric junction outflow obstruction, respectively, using Chicago classification 4.0. In 249/453 (55.0%) patients initially diagnosed with esophagogastric junction outflow obstruction using Chicago classification 3.0, the diagnosis was changed to achalasia (n = 28), hypercontractile esophagus (n = 7), ineffective esophageal motility (n = 7), or normal esophageal function (n = 121) using Chicago classification 4.0. Rapid drink challenge-integrated relaxation pressure's diagnostic cutoff value was 19 mmHg. Nine patients had diagnoses changed after the rapid drink challenge, including 3 with panesophageal pressurization.

Conclusions: Chicago classification 4.0 increased the diagnostic yield of the rapid drink challenge by 2.0% (9/453 patients). However, the rapid drink challenge had a failure rate of 17.9% (99/552 patients). Given the relatively low diagnostic yield and high failure rate of the rapid drink challenge, we recommend adopting an individualized approach to manometry.

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芝加哥快速饮品挑战分类 4.0 版与 3.0 版相比的额外诊断结果。
背景/目的:芝加哥分类法 4.0 版通过体位改变和诱导试验(如多次快速吞咽和快速饮水挑战)加强了食管运动障碍的诊断。本研究通过使用功能性管腔成像探针估算临界值,探讨了基于芝加哥分类 4.0 的快速饮水挑战的诊断作用:本研究纳入了 570 名在 2019 年 1 月至 2022 年 10 月期间接受食管测压和快速饮料挑战的患者。诊断流程根据芝加哥分类 4.0 进行分析:99名患者(38名,贲门失弛缓症;11名,食管胃交界处流出道梗阻;7名,食管运动功能不全;1名,食管过度收缩;42名,食管功能正常)未能通过快速饮料挑战。在 453 名参与者中,根据芝加哥分类 4.0,分别有 50 人和 86 人被诊断为贲门失弛缓症和食管胃交界处流出道梗阻。249/453(55.0%)名患者最初使用芝加哥分级 3.0 诊断为食管胃交界处流出道梗阻,后来使用芝加哥分级 4.0 诊断改为贲门失弛缓症(28 人)、食管过度收缩(7 人)、食管运动功能不全(7 人)或食管功能正常(121 人)。快速饮水挑战综合松弛压的诊断临界值为 19 mmHg。九名患者的诊断在快速饮料挑战后发生了改变,其中包括三名食管泛压患者:芝加哥分级 4.0 将快速饮水挑战的诊断率提高了 2.0%(9/453 名患者)。然而,快速饮水挑战的失败率为 17.9%(99/552 名患者)。鉴于快速饮水挑战的诊断率相对较低且失败率较高,我们建议采用个体化的测压方法。
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来源期刊
Journal of Neurogastroenterology and Motility
Journal of Neurogastroenterology and Motility GASTROENTEROLOGY & HEPATOLOGY-CLINICAL NEUROLOGY
CiteScore
6.30
自引率
8.80%
发文量
96
期刊介绍: Journal of Neurogastroenterology and Motility (J Neurogastroenterol Motil) is a joint official journal of the Korean Society of Neurogastroenterology and Motility, the Thai Neurogastroenterology and Motility Society, the Japanese Society of Neurogastroenterology and Motility, the Indian Motility and Functional Disease Association, the Chinese Society of Gastrointestinal Motility, the South East Asia Gastro-Neuro Motility Association, the Taiwan Neurogastroenterology and Motility Society and the Asian Neurogastroenterology and Motility Association, launched in January 2010 after the title change from the Korean Journal of Neurogastroenterology and Motility, published from 1994 to 2009.
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