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Achalasia Diagnosis by High-Resolution Manometry According to Chicago Classification

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Esfandyari, Tuba MD, MSc; Reddymasu, Savio MD; Olyaee, Mojtaba MD

American Journal of Gastroenterology: October 2010 - Volume 105 - Issue - p S9
Abstracts: ESOPHAGUS
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Kansas University Medical Center, Kansas City, KS.

Purpose: Diagnosis of achalasia relies on demonstrating impaired gastroesophageal junction (GEJ) relaxation and aperistalsis. Three distinct patterns of aperistalsis have been proposed using high-resolution manometry (HRM) by Chicago Group. However, there has been no other independent evaluation of this classification. The purpose of our study is to compare the clinical characteristics of the 3 subtypes of achalasia based on Chicago classification.

Methods: HRM studies performed at Kansas University Medical Center between January 2008 to October 2009 were reviewed. Patients with impaired GEJ relaxation and functional obstruction were excluded from the study. All patients with diagnosis of achalasia were identified and classified into 3 groups: achalasia with minimal esophageal pressurization (type I, classic), achalasia with esophageal compression (type II), achalasia with spasm (type III), using Chicago classification.

Results: Total of 36 patients with impaired GEJ relaxation was identified, with mean age 58 years, 21 female (F, 62%) and 15 male (M, 42%). All were complaining of dysphagia with mean duration of 10 years, ranging from 2 months to 30 years. The characteristics of 3 types of achalasia are summarized as below: Classic achalasia Type I: (n=3, 2 M, 1 F), mean age 65 years, chest pain 25%, dysphagia duration 4 years. Achalasia with compression Type II: (n=25, 11 M, 14 F), mean age 58 years, chest pain 45%, dysphagia duration 13 years. Achalasia with spasm, Type III: (n=8, 2 M, 6 F), mean age 60 years, chest pain 68%, dysphagia duration 8 years.

Conclusion: Type II achalasia is the most common type among our patients. We plan to evaluate the correlation of clinical characteristics to management outcome and treatment response in the 3 subtypes of achalasia, using logistic regression analysis.

© The American College of Gastroenterology 2010. All Rights Reserved.