Esophageal motility disorders in terms of pressure topography - The Chicago classification
Esophageal motility disorders in terms of pressure topography - The Chicago classification
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DOI：
10.1097/mcg.0b013e31815ea291
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发表时间：
2008-05-01
影响因子：
2.9
通讯作者：
Pandolfino, John E.
中科院分区：
文献类型：
--
作者：
Kahrilas, Peter J.;Ghosh, Sudip K.;Pandolfino, John E.
最近的两项进展彻底改变了临床食管测压的性能；引入实用的高分辨率测压 (FIRM) 系统并开发复杂的算法，以将扩展的测压数据集显示为压力地形图。我们利用 400 名连续患者和 75 名对照受试者的大量临床经验，开发了一种使用 HRM 和压力地形图分析食管运动的系统方法。由此产生的分类方案被命名为食管运动芝加哥分类。与传统测压记录相比，压力地形图的两个优点是能够（1）描绘食管上各个收缩节段的空间限制、活力和完整性，以及（2）区分分区食管内加压和快速传播收缩的位点。进行这些区分可以客观地识别远端食管痉挛、严重贲门失弛缓症、功能性梗阻和胡桃夹食管亚型。应用这些区别使得痉挛性疾病的诊断相当罕见：1.5% 的患者出现痉挛，1.5% 的患者出现剧烈贲门失弛缓症，1.5% 的患者出现新定义的痉挛性胡桃夹症。最终，进一步的临床经验将成为判断标准，但我们期望 HRM 数据的压力地形分析及其明确的功能含义将在食管运动障碍的临床管理中证明有价值。
Two recent advances have revolutionized the performance of clinical esophageal manometry; the introduction of practical high resolution manometry (FIRM) systems and the development of sophisticated algorithms to display the expanded manometric dataset as pressure topography plots. We utilized a large clinical experience of 400 consecutive patients and 75 control subjects to develop a systematic approach to analyzing esophageal motility using HRM and pressure topography plots. The resultant classification scheme has been named as the Chicago Classification of esophageal motility. Two strengths of pressure topography plots compared with conventional manometric recordings were the ability to (1) delineate the spatial limits, vigor, and integrity of individual contractile segments along the esophagus and (2) to distinguish between loci of compartmentalized intraesophageal pressurization and rapidly propagated contractions. Making these distinctions objectified the identification of distal esophageal spasm, vigorous achalasia, functional obstruction, and nutcracker esophagus subtypes. Applying these distinctions made the diagnosis of spastic disorders quite rare: spasm in 1.5% of patients, vigorous achalasia in 1.5%, and a newly defined entity, spastic nutcracker, in 1.5%. Ultimately, further clinical experience will be the judge, but it is our expectation that pressure topography analysis of HRM data, along with its well-defined functional implications, will prove valuable in the clinical management of esophageal motility disorders.