# Evaluating the Frequency of Esophageal Motility Disorders in Patients With Upper Gastrointestinal Symptoms Based on the Chicago Classification Version 3.0

## TL;DR

This study found that nearly half of patients with upper GI symptoms had esophageal motility disorders, with those experiencing dysphagia being more likely to have these disorders.

## Contribution

The study provides new insights into the frequency of esophageal motility disorders in Japanese patients with upper GI symptoms using the Chicago Classification v3.0.

## Key findings

- 45.3% of patients with upper GI symptoms had esophageal motility disorders based on HRM and CC v3.0.
- Patients with dysphagia had a significantly higher rate (65.3%) of esophageal motility disorders.
- Achalasia type I-III was diagnosed in 45.5% of dysphagia patients with motility disorders.

## Abstract

Introduction: Patients with upper gastrointestinal (GI) symptoms may have esophageal motility disorders (EMDs). Esophageal high-resolution manometry (HRM) is often performed when no obvious abnormalities are observed on esophagogastroduodenoscopy (EGD). However, few reports from Japan have evaluated the relationship between symptoms and EMDs in a large number of patients from a single institution. This study aimed to elucidate the frequency of EMDs and the relationship between patient symptoms and EMDs by evaluating HRM findings based on the Chicago Classification version 3.0 (CC v3.0).

Methods: A total of 258 patients with upper GI symptoms (258 examinations) who had no organic abnormalities on EGD and underwent their first HRM at our institution between July 2013 and May 2022 were enrolled. We retrospectively analyzed the proportion of EMDs in patients with upper GI symptoms and examined the relationship between upper GI symptoms and EMDs.

Results: The mean age of the patients was 57 ± 15 years, and 42.4% were male. The most common symptom was dysphagia, observed in 101 patients (39.1%), followed by heartburn in 51 patients (19.8%). The proportion of EMDs based on CC v3.0 was 45.3% (117 of 258 patients) among all patients with upper GI symptoms and 65.3% (66 of 101 patients) among those with dysphagia; this difference was statistically significant (p < 0.001). Additionally, various types of EMDs were observed in patients with dysphagia including 45.5% (30 of 66 patients) of patients diagnosed as achalasia type I-III.

Conclusion: 45.3% of the patients with upper GI symptoms were diagnosed with EMDs on HRM based on CC v3.0. Patients presenting with dysphagia were more likely to have EMDs. HRM may be a useful diagnostic modality for patients with upper GI symptoms who have no organic abnormalities on EGD. In particular, HRM should be considered in daily clinical practice for patients with dysphagia, given the potential presence of EMDs, including achalasia.