The application of Chicago classification 4.0 in esophageal motility disorders of scleroderma: a case-control study in China
- 1Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University
- 2Johns Hopkins University School of Medicine
- 3Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University
Abstract
Background: Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by multi-organ fibrosis and vasculopathy that frequently involves the esophagus. This study assessed esophageal motility disorders in patients with SSc using High-resolution manometry (HRM) and classified these disorders according to the Chicago Classification version 4.0, aims to investigate the associations between esophageal dysfunction and clinical phenotypes in Chinese SSc patients, while exploring potential modifications to enhance the applicability of the Chicago v4.0 protocol in SSc patients.
Methods: We retrospectively identified SSc patients fulfilling 2013 ACR criteria who underwent HRM classified by Chicago v4.0 at our center (2021–2023). Demographics, organ involvement, pulmonary-function tests, echocardiography and reflux symptom scores (RDQ/GERDQ) were extracted from the hospital information system; age and sex matched non-SSc HRM subjects served as controls. Associations between Chicago categories and clinical variables were examined by multinomial logistic regression.
Results: In our study, esophageal motility disorders were present in 76.7% of patients with systemic sclerosis, predominantly characterized by ineffective esophageal motility (IEM) (35%) and absent contractility (AC) (36.67%). The occurrence rate of AC rose with age. Symptoms of gastroesophageal reflux were more common in the AC group [Odds Ratio: 3.23 (1.02-10.22) vs 1.43(0.52-3.95), P<0.05, E value=2.99]. Diffusion capacity for carbon monoxide (DLCO) was significantly reduced in both IEM and AC (-2.03 vs -2.70, P value<0.05), with a more pronounced decrease in AC. Total lung capacity (TLC) and forced expiratory volume in one second (FEV1) exhibited stronger associations with AC (-1.04 and -0.8 respectively, p value<0.05). Upright HRM revealed more marked decreases in EGJ pressure and distal contractile integral (DCI) relative to the supine position in SSc patients, indicating that esophageal abnormalities may be more readily apparent during upright examination.
Conclusions: Esophageal motility disorders in SSc were common and significantly associated with older age, gastroesophageal reflux symptoms, and reduced lung function. Future studies are needed to clarify whether early esophageal motility disorders are associated with disease progression and prognosis in patients.
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BibTeX
@article{yang2026application,
title = {{The application of Chicago classification 4.0 in esophageal motility disorders of scleroderma: a case-control study in China}},
author = {Yinghui Yang and Siwei Xie and Minyi Xu and Zhiming Lin and Yanli Zhang},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1962332},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1962332/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The application of Chicago classification 4.0 in esophageal motility disorders of scleroderma: a case-control study in China
AU - Yinghui Yang
AU - Siwei Xie
AU - Minyi Xu
AU - Zhiming Lin
AU - Yanli Zhang
PY - 2026
DA - 2026/10/05
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1962332
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1962332/full
AB - Background: Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by multi-organ fibrosis and vasculopathy that frequently involves the esophagus. This study assessed esophageal motility disorders in patients with SSc using High-resolution manometry (HRM) and classified these disorders according to the Chicago Classification version 4.0, aims to investigate the associations between esophageal dysfunction and clinical phenotypes in Chinese SSc patients, while exploring potential modifications to enhance the applicability of the Chicago v4.0 protocol in SSc patients. Methods: We retrospectively identified SSc patients fulfilling 2013 ACR criteria who underwent HRM classified by Chicago v4.0 at our center (2021–2023). Demographics, organ involvement, pulmonary-function tests, echocardiography and reflux symptom scores (RDQ/GERDQ) were extracted from the hospital information system; age and sex matched non-SSc HRM subjects served as controls. Associations between Chicago categories and clinical variables were examined by multinomial logistic regression. Results: In our study, esophageal motility disorders were present in 76.7% of patients with systemic sclerosis, predominantly characterized by ineffective esophageal motility (IEM) (35%) and absent contractility (AC) (36.67%). The occurrence rate of AC rose with age. Symptoms of gastroesophageal reflux were more common in the AC group [Odds Ratio: 3.23 (1.02-10.22) vs 1.43(0.52-3.95), P<0.05, E value=2.99]. Diffusion capacity for carbon monoxide (DLCO) was significantly reduced in both IEM and AC (-2.03 vs -2.70, P value<0.05), with a more pronounced decrease in AC. Total lung capacity (TLC) and forced expiratory volume in one second (FEV1) exhibited stronger associations with AC (-1.04 and -0.8 respectively, p value<0.05). Upright HRM revealed more marked decreases in EGJ pressure and distal contractile integral (DCI) relative to the supine position in SSc patients, indicating that esophageal abnormalities may be more readily apparent during upright examination. Conclusions: Esophageal motility disorders in SSc were common and significantly associated with older age, gastroesophageal reflux symptoms, and reduced lung function. Future studies are needed to clarify whether early esophageal motility disorders are associated with disease progression and prognosis in patients.
SN - 1664-3224
ER -