{
  "abstract": "Introduction Esophageal dysfunction is a frequent and disabling feature of systemic sclerosis (SSc). High-resolution manometry (HRM) enables diagnosis through the Chicago Classification (CC). The latest version, CCv4.0, incorporates supine and upright metrics, but its role in SSc remains unassessed. We aimed to compare CCv4.0 protocol outcomes with CCv3.0 (which includes only the supine position) and upright-only protocols in SSc patients.Material and Methods Retrospective single-center study conducted in a tertiary centre. All included patients were diagnosed with SSc according to ACR/EULAR 2013 or VEDOSS criteria. Data on sociodemographic, clinical, and esophageal manometry findings were collected prospectively since the introduction of a new manometry protocol (based on CCv4.0 criteria) in 2020. Manometry reports were analyzed for the final diagnosis (based on the CCv4.0 criteria). Additionally, both the supine position (according to the CCv3.0 criteria) and upright position were classified considering the findings observed. Statistical analysis was performed using Cohen’s kappa test to evaluate the agreement between categorical variables.Results A total of 58 patients with SSc (93.1% female; mean age at diagnosis 53.3±12.7 years) were evaluated ( table 1). Fifty-two (89.7%) met ACR/EULAR 2013 criteria and 6 met VEDOSS criteria. Limited cutaneous scleroderma (63.8) was the predominant subtype and 65.5% reported esophageal/gastric symptoms (32.1% at diagnosis). Half of the patients (50%) had normal HRM findings, while the most common abnormalities were ineffective esophageal motility (IEM) (17.2%), absent contractility (13.8%), and esophagogastric junction (EGJ) outflow obstruction (6.9%). Substantial agreement (table 2) was observed between CCv4.0 protocol and supine-only (k = 0.748; p < 0.001) and upright-only (k = 0.762; p < 0.001), with moderate agreement between supine-only and upright-only (k = 0.599; p < 0.001). Among 6 patients with inconclusive results due to supine intolerance, upright manometry successfully provided a diagnosis.Conclusions The Chicago 4.0 protocol demonstrated significant agreement with both supine (and upright) diagnoses but highlighted the complementary value of upright positioning, especially for patients intolerant to the supine position or presenting with inconclusive findings. Although this combined approach ensures a more comprehensive assessment of esophageal function in SSc, the use of only the upright position may be sufficient in this population, simplifying the protocol in the future and reducing the associated discomfort. Further studies are required to validate these findings and explore their implications for SSc management strategies. This is the first study to evaluate the applicability of the CCv4.0 manometry criteria in patients with SSc.Abstract OC.50 Table 1Sociodemographic, elinical and manometry data in patents with systamic selaresis (SSe)Abstract OC.50 Table 2Comparison of manometry diagnostic outcomes using the Chicago 4.0 protocol versus diagnoses obtained in supine position only (as per Chicago 3.0 protocol) or upright position only",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Carlos Gomes"
    },
    {
      "affiliations": [
        "Gastroenterology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Francisco Mendes"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Mariana Diz-Lopes"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Miguel Natal"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Bárbara Esteves"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Sara Amaro"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Ana Sá"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de Viseu, Viseu, Portugal"
      ],
      "name": "Marina Oliveira"
    },
    {
      "affiliations": [
        "Rheumatology Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal"
      ],
      "name": "Mariana Sebastião"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Miguel Bernardes"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Lúcia Costa"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Raquel Ferreira"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Georgina Terroso"
    },
    {
      "affiliations": [
        "Gastroenterology Department, Unidade Local de Saúde de São João, Porto, Portugal"
      ],
      "name": "Armando Peixoto"
    }
  ],
  "title": "OC.50 Applicability and diagnostic value of Chicago classification 4.0 in assessing esophageal motility disorders in systemic sclerosis: a retrospective single-center study",
  "uid": "ecce40dc-a200-5718-8450-3f9983a4a0d1"
}