Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 1, February 2023, pages 37-49

Comparing Patients Diagnosed With Ineffective Esophageal Motility by the Chicago Classification Version 3.0 and Version 4.0 Criteria

Figure 1. Prevalence of specific digestive system disorders among patients with a digestive system comorbidity among: (a) CCv4.0 IEM patients (n = 128) and (b) CCv3.0 only IEM patients (n = 46), 2011 - 2019.

Figure 2. Prevalence of medication classes used by: (a) CCv4.0 IEM patients (n = 128) and (b) CCv3.0 only IEM patients (n = 46), 2011 - 2019.

Figure 3. Correlation of mean LES pressure with: (a) Percent of failed contractions among CCv4.0 IEM patients (n = 128) (r = -0.0409, P = 0.6473), (b) Percent of ineffective contractions among CCv4.0 IEM patients (n = 128) (r = -0.2495, P = 0.0050), (c) Percent of failed contractions among CCv3.0 only IEM patients (n = 46) (r = -0.4875, P < 0.001), (d) Percent of ineffective contractions among CCv3.0 only IEM patients (n = 46) (r = -0.2954, P = 0.0507), (e) Percent of failed contractions in all patients combined (n = 174) (r = -0.1172, P = 0.1249), and (f) Percent of ineffective contractions in all patients combined (n = 174) (r = -0.1942, P = 0.0108).

Figure 4. Correlation of median IRP with: (a) Percent of failed contractions among CCv4.0 IEM patients (n = 128) (r = -0.1202, P = 0.1785), (b) Percent of ineffective contractions among CCv4.0 IEM patients (n = 128) (r = -0.1825, P = 0.0407), (c) Percent of failed contractions among CCv3.0 only IEM patients (n = 46) (r = -0.3036, P = 0.0445), (d) Percent of ineffective contractions among CCv3.0 only IEM patients (n = 46) (r = -0.0587, P = 0.7000), (e) Percent of failed contractions in all patients combined (n = 174) (r = -0.1533, P = 0.0445), and (f) Percent of ineffective contractions in all patients combined (n = 174) (r = -0.1163, P = 0.1277).

Figure 5. The conversion of HRM diagnoses from 25 patients from three separate time points - (1) HRM diagnosis prior to study HRM, (2) Study HRM diagnosis of IEM, and (3) HRM diagnosis following study HRM - into “first HRM diagnosis” and “second HRM diagnosis,” 2011 - 2019.

Figure 6. Frequency of initial and follow-up HRM diagnoses for patients diagnosed with IEM from 2011 to 2019 and with more than one HRM study (n = 25), including mean time interval in months (including range) between the initial and follow-up studies.

**Table 1.** Frequency of Demographic and Clinical Characteristics Among CCv4.0 IEM Patients (n = 128) and CCv3.0 Only IEM Patients (n = 46), 2011 - 2019
	Group 1: CCv4.0 patients (n = 128)	Group 2: CCv3.0 only patients (n = 46)	P-value
^aWilcoxon rank-sum test. ^bFisher’s exact test. P < 0.05; P < 0.01; **P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0.
Median age in years (interquartile range)	54.50 (26)	54 (23.25)	0.4344^a
Gender, n (%)			0.9243^b
Female	90 (70.3%)	32 (69.6%)
Male	38 (29.7%)	14 (30.4%)
Race, n (%)			0.1159*^b
White	112 (87.5%)	45 (97.8%)
Non-white	13 (10.2%)	1 (2.2%)
Unavailable	3 (2.3%)	0 (0%)
Body mass index category, n (%)			0.5529^b
Underweight	6 (3.61%)	2 (4.44%)
Normal	38 (22.89%)	11 (24.44%)
Overweight	51 (30.72%)	9 (20.00%)
Obese/morbidly obese	71 (42.77%)	23 (51.11%)
Comorbidity, n (%)
Digestive system disorder	119 (93.0%)	46 (100.0%)	0.0648^b
Endocrine system, metabolic, or nutritional disorder	74 (57.8%)	30 (65.2%)	0.3797^b
Mood disorder	73 (57.0%)	23 (50.0%)	0.4108^b
Circulatory system disorder	65 (50.8%)	22 (47.8%)	0.8637^b
Nervous system disorder	44 (34.4%)	23 (50.0%)	0.0618^b
Respiratory system disorder	35 (27.3%)	17 (37.0%)	0.2607^b
Neoplasms	24 (18.8%)	9 (19.6%)	1.0000^b
Disorders of the blood, blood-forming organs, and certain disorders involving the immune mechanism	17 (13.3%)	14 (30.4%)	0.0132*^b
Musculoskeletal or connective tissue disorder	11 (8.7%)	6 (13.0%)	0.3923^b

Table 1. Frequency of Demographic and Clinical Characteristics Among CCv4.0 IEM Patients (n = 128) and CCv3.0 Only IEM Patients (n = 46), 2011 - 2019

Group 1: CCv4.0 patients (n = 128)

Group 2: CCv3.0 only patients (n = 46)

P-value

^aWilcoxon rank-sum test. ^bFisher’s exact test. *P < 0.05; **P < 0.01; ***P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0.

Median age in years (interquartile range)

54.50 (26)

54 (23.25)

0.4344^a

Gender, n (%)

0.9243^b

Female

90 (70.3%)

32 (69.6%)

Male

38 (29.7%)

14 (30.4%)

Race, n (%)

0.1159*^b

White

112 (87.5%)

45 (97.8%)

Non-white

13 (10.2%)

1 (2.2%)

Unavailable

3 (2.3%)

0 (0%)

Body mass index category, n (%)

0.5529^b

Underweight

6 (3.61%)

2 (4.44%)

Normal

38 (22.89%)

11 (24.44%)

Overweight

51 (30.72%)

9 (20.00%)

Obese/morbidly obese

71 (42.77%)

23 (51.11%)

Comorbidity, n (%)

Digestive system disorder

119 (93.0%)

46 (100.0%)

0.0648^b

Endocrine system, metabolic, or nutritional disorder

74 (57.8%)

30 (65.2%)

0.3797^b

Mood disorder

73 (57.0%)

23 (50.0%)

0.4108^b

Circulatory system disorder

65 (50.8%)

22 (47.8%)

0.8637^b

Nervous system disorder

44 (34.4%)

23 (50.0%)

0.0618^b

Respiratory system disorder

35 (27.3%)

17 (37.0%)

0.2607^b

Neoplasms

24 (18.8%)

9 (19.6%)

1.0000^b

Disorders of the blood, blood-forming organs, and certain disorders involving the immune mechanism

17 (13.3%)

14 (30.4%)

0.0132*^b

Musculoskeletal or connective tissue disorder

11 (8.7%)

6 (13.0%)

0.3923^b

**Table 2.** Average Manometric Findings Among CCv4.0 IEM Patients (n = 128) and CCv3.0 Only IEM Patients (n = 46), 2011 - 2019
Average manometric findings (mean ± SD)	Group 1: CCv4.0 patients (n = 128)	Group 2: CCv3.0 only patients (n = 46)	P-value
P < 0.05; P < 0.01; **P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0; SD: standard deviation; LES: lower esophageal sphincter; IRP: integrated relaxation pressure.
% Weak contractions	41.26 ± 29.10%	41.55 ± 16.05%	0.934
% Failed contractions	46.63 ± 25.92%	19.22 ± 14.97%	< 0.001***
% Ineffective contractions	87.88 ± 11.88%	60.77 ± 8.15%	< 0.001***
Mean LES pressure	18.69 ± 12.63 mm Hg	19.83 ± 13.60 mm Hg	0.621
Median IRP	3.96 ± 5.50 mm Hg	4.42 ± 6.86 mm Hg	0.683
% Swallows followed by cleared bolus	12.50 ± 19.50%	17.78 ± 16.76%	0.083

Table 2. Average Manometric Findings Among CCv4.0 IEM Patients (n = 128) and CCv3.0 Only IEM Patients (n = 46), 2011 - 2019

Average manometric findings (mean ± SD)

Group 1: CCv4.0 patients (n = 128)

Group 2: CCv3.0 only patients (n = 46)

P-value

*P < 0.05; **P < 0.01; ***P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0; SD: standard deviation; LES: lower esophageal sphincter; IRP: integrated relaxation pressure.

% Weak contractions

41.26 ± 29.10%

41.55 ± 16.05%

0.934

% Failed contractions

46.63 ± 25.92%

19.22 ± 14.97%

< 0.001***

% Ineffective contractions

87.88 ± 11.88%

60.77 ± 8.15%

< 0.001***

Mean LES pressure

18.69 ± 12.63 mm Hg

19.83 ± 13.60 mm Hg

0.621

Median IRP

3.96 ± 5.50 mm Hg

4.42 ± 6.86 mm Hg

0.683

% Swallows followed by cleared bolus

12.50 ± 19.50%

17.78 ± 16.76%

0.083

**Table 3.** Correlation of Mean LES Pressure and Median IRP With Percent of Failed and Ineffective Contractions Among CCv4.0 IEM Patients (n = 128), CCv3.0 Only IEM Patients (n = 46), and All Patients Combined (n = 174), 2011 - 2019
	Group 1: CCv4.0 patients (n = 128)	Group 2: CCv3.0 only patients (n = 46)	All patients combined (n = 174)
Spearman correlation test. P < 0.05; P < 0.01; **P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0; LES: lower esophageal sphincter; IRP: integrated relaxation pressure.
Mean LES pressure
Percent of failed contractions	r = -0.0409; P = 0.6473	r = -0.4875; P < 0.001***	r = -0.1172; P = 0.1249
Percent of ineffective contractions	r = -0.2495; P = 0.0050**	r = -0.2954; P = 0.0507	r = -0.1942; P = 0.0108*
Median IRP
Percent of failed contractions	r = -0.1202; P = 0.1785	r = -0.3036; P = 0.0445*	r = -0.1533; P = 0.0445*
Percent of ineffective contractions	r = -0.1825; P = 0.0407*	r = -0.0587; P = 0.7000	r = -0.1163; P = 0.1277

Table 3. Correlation of Mean LES Pressure and Median IRP With Percent of Failed and Ineffective Contractions Among CCv4.0 IEM Patients (n = 128), CCv3.0 Only IEM Patients (n = 46), and All Patients Combined (n = 174), 2011 - 2019

Group 1: CCv4.0 patients (n = 128)

Group 2: CCv3.0 only patients (n = 46)

All patients combined (n = 174)

Spearman correlation test. *P < 0.05; **P < 0.01; ***P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0; LES: lower esophageal sphincter; IRP: integrated relaxation pressure.

Mean LES pressure

Percent of failed contractions

r = -0.0409; P = 0.6473

r = -0.4875; P < 0.001***

r = -0.1172; P = 0.1249

Percent of ineffective contractions

r = -0.2495; P = 0.0050**

r = -0.2954; P = 0.0507

r = -0.1942; P = 0.0108*

Median IRP

Percent of failed contractions

r = -0.1202; P = 0.1785

r = -0.3036; P = 0.0445*

r = -0.1533; P = 0.0445*

Percent of ineffective contractions

r = -0.1825; P = 0.0407*

r = -0.0587; P = 0.7000

r = -0.1163; P = 0.1277

**Table 4.** Correlation of Incomplete Bolus Clearance With Percent of Weak, Failed, and Ineffective Contractions Among CCv4.0 IEM Patients (n = 128), CCv3.0 Only IEM Patients (n = 46), and All Patients Combined (n = 174), 2011 - 2019
	Incomplete bolus clearance vs. percent of weak contractions	Incomplete bolus clearance vs. percent of failed contractions	Incomplete bolus clearance vs. percent of ineffective contractions
Spearman correlation test. P < 0.05; P < 0.01; **P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0.
Group 1: CCv4.0 patients (n = 128)	r = -0.2707; P = 0.0054**	r = 0.3689; P = 0.0001***	r = 0.1511; P = 0.1226
Group 2: CCv3.0 only patients (n = 46)	r = 0.0231; P = 0.8837	r = 0.1168; P = 0.4595	r = 0.2930; P = 0.0616
All patients combined (n = 174)	r = -0.2176; P = 0.0081**	r = 0.3859; P = 0.000002***	r = 0.2716; P = 0.0009***

Table 4. Correlation of Incomplete Bolus Clearance With Percent of Weak, Failed, and Ineffective Contractions Among CCv4.0 IEM Patients (n = 128), CCv3.0 Only IEM Patients (n = 46), and All Patients Combined (n = 174), 2011 - 2019

Incomplete bolus clearance vs. percent of weak contractions

Incomplete bolus clearance vs. percent of failed contractions

Incomplete bolus clearance vs. percent of ineffective contractions

Spearman correlation test. *P < 0.05; **P < 0.01; ***P < 0.001. IEM: ineffective esophageal motility; CCv4.0: Chicago Classification v4.0; CCv3.0: Chicago Classification v3.0.

Group 1: CCv4.0 patients (n = 128)

r = -0.2707; P = 0.0054**

r = 0.3689; P = 0.0001***

r = 0.1511; P = 0.1226

Group 2: CCv3.0 only patients (n = 46)

r = 0.0231; P = 0.8837

r = 0.1168; P = 0.4595

r = 0.2930; P = 0.0616

All patients combined (n = 174)

r = -0.2176; P = 0.0081**

r = 0.3859; P = 0.000002***

r = 0.2716; P = 0.0009***