Table 3.

Disorders of Peristalsis

DES

Manometric diagnosis of DES is defined as the presence of at least 20% premature contractions (distal latency <4.5 s) and DCI >450 mm Hg-s-cm

Some normal peristalsis is no longer required

A diagnosis of DES requires clinically relevant symptoms (dysphagia and/or noncardiac chest pain) and manometric criteria HE

Manometric diagnosis of HE is defined as 20% or more hypercontractile, supine swallows (DCI >8000 mm Hg- s-cm)

Must have clinically relevant symptoms (dysphagia/ noncardiac chest pain)

A diagnosis of HE can only be made when criteria for achalasia/DES are not met and mechanical obstruction has been excluded

IEM

A diagnosis of IEM requires more than 70% ineffective swallows (DCI >100 mm Hg-s-cm but <450 mm Hg- s-cm) or at least 50% failed peristalsis (DCI <100 mm Hg-s-cm)

The presence of 50% to 70% ineffective swallows is inconclusive for a diagnosis of IEM. Supportive testing is required, including – Poor bolus transit on impedance or barium esophagram – Lack of contraction reserve on multiple rapid swallows

The term fragmented peristalsis should no longer be used

Absent Contractility

A diagnosis of absent contractility is defined as normal median IRP in the supine and upright positions and 100% failed peristalsis

Bold text indicates important new criteria in Chicago Classification version 4.0.

DCI, distal contractile integral; DES, distal esophageal spasm; HE, hyper-contractile (jackhammer) esophagus; IEM, ineffective esophageal motility; IRP, integrated relaxation pressure.