Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©

Rena Yadlapati, Peter J. Kahrilas, Mark R. Fox, Albert J. Bredenoord, C. Prakash Gyawali, Sabine Roman, Arash Babaei, Ravinder K. Mittal, Nathalie Rommel, Edoardo Savarino, Daniel Sifrim, André Smout, Michael F. Vaezi, Frank Zerbib, Junichi Akiyama, Shobna Bhatia, Serhat Bor, Dustin A. Carlson, Joan W. Chen, Daniel CisternasCharles Cock, Enrique Coss-Adame, Nicola de Bortoli, Claudia Defilippi, Ronnie Fass, Uday C. Ghoshal, Sutep Gonlachanvit, Albis Hani, Geoffrey S. Hebbard, Kee Wook Jung, Philip Katz, David A. Katzka, Abraham Khan, Geoffrey Paul Kohn, Adriana Lazarescu, Johannes Lengliner, Sumeet K. Mittal, Taher Omari, Moo In Park, Roberto Penagini, Daniel Pohl, Joel E. Richter, Jordi Serra, Rami Sweis, Jan Tack, Roger P. Tatum, Radu Tutuian, Marcelo F. Vela, Reuben K. Wong, Justin C. Wu, Yinglian Xiao, John E. Pandolfino

Research output: Contribution to journalArticlepeer-review

238 Citations (Scopus)


Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.

Original languageEnglish
Article numbere14058
Number of pages21
JournalNeurogastroenterology and Motility
Issue number1
Publication statusPublished - Jan 2021


  • achalasia
  • esophageal spasm
  • integrated relaxation pressure
  • lower esophageal sphincter
  • peroral endoscopic myotomy


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