DISTAL ESOPHAGEAL SPASM: DIAGNOSTIC AGREEMENT BETWEEN THE CHICAGO 4.0 CLASSIFICATION AND THE VALUES OF A BRAZILIAN MULTICENTRIC STUDY
distal esophageal spasm; Chicago rating 4.0; brazilian cohort; dysphagia; chest pain
Distal esophageal spasm (DSE) is a primary disorder of the esophagus that is mainly manifested by dysphagia and chest pain. High-resolution esophageal manometry is the test of choice for assessing the organ's motor function and the diagnoses obtained follow the criteria established by the Chicago Classification 4.0 (CCv4.0), developed in 2020 from probes with solid-state sensors. A Brazilian cohort (CB), however, using probes with water perfusion, found reference values different from CCv4.0. To assess the diagnostic agreement between the classifications, the exams of 783 patients were reported according to the two classifications and the results were correlated with the presence or absence of dysphagia and chest pain through the interclass correlation coefficient, a set of univariate and multivariate models and finally, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Data were analyzed using the R Studio computational program and R language version 4.0.1 (R Development Core Team, New Zealand). There was a low magnitude of correlation with the two criteria and, therefore, the use of BS should be discouraged for diagnosing DSE when done in isolation. The metric that most altered the accuracy of the test was the DCI, and it was established that the value of 623.15 mmHg is the point on the ROC curve with the best values. Thus, a (multivariate) algorithm that includes the average DCI value and the CB diagnostic criterion for DSE could constitute a simple mechanism and more strongly related to clinical symptoms compatible with EED. KEYWORDS: distal esophageal spasm; Chicago rating 4.0; brazilian cohort; dysphagia; chest pain.