Ineffective Motility Revisited Through High-Resolution Manometry After Chicago Classification v4.0

Objectives “Ineffective motility” (IM) is a motility disorder characterised by weakened and uncoordinated muscle contractions in the oesophagus, leading to regurgitation and swallowing difficulties. This study aims to redefine cases previously labelled as IM using CCv3.0 and redefine such cases in high-resolution manometry (HRM) in CCv4.0. Material and Methods A retrospective study on 366 dysphagia patients was conducted at Holy Family Hospital, Rawalpindi, Pakistan, from December 2015 to October 2023. Based on CCv3.0, 71 cases were evaluated. They were reanalysed using Solar™ GI HRM, Laborie, to compare with CCv4.0. Analysis was performed using statistical package for the social sciences (SPSS) 25.0. Results Upon re-evaluation using CCv4.0, 90% of initially identified IM cases remained, reducing the estimated prevalence from 19.4% to 17.5%. Mean LES pressure and mean IRP were inversely correlated with the percentage of absent swallows. In contrast, mean IRP showed a positive correlation with the rate of ineffective contractions. Demographics and baseline characteristics showed no significant differences between the two groups. Conclusion This study strongly supports the efficacy of CCv4.0 in better categorising IM once deemed minor. It calls for prospective research focusing on clinical endpoints and diagnostic criteria refinement. The diverse IM spectrum suggests further studies for subgroup classification enhancement.