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Therapeutic Outcome of Achalasia Based on High-Resolution Manometry

A Korean Multicenter Study

Lee, Hyuk MD1; Chung, Hyunsoo MD2; Lee, Tae Hee MD3; Hong, Kyoung Sup MD2; Youn, Young Hoon MD4; Park, Jung Ho MD5; Park, Hyung Seok MD6; Park, Hyojin MD4,* Korean Achalasia Study Team (KAST)

doi: 10.1097/MJT.0000000000000677
Original Investigation

Background: Because achalasia subtype is associated with therapeutic response, it is possible that regional differences in subtype distribution could lead to differences in therapeutic outcomes.

Study Question: We aimed to evaluate and compare high-resolution manometry (HRM) profiles among the different subtypes of achalasia and to elucidate predictive factors associated with treatment outcomes.

Study Design: Patients who were diagnosed with achalasia using HRM at 4 Korean university hospitals were retrospectively identified and analyzed. Sixty-four patients with untreated achalasia were divided into 3 subtypes using the Chicago classification system.

Measures and Outcomes: Clinical characteristics, manometric features, and treatment outcomes were compared.

Results: Among 64 patients diagnosed with achalasia, 31 patients were classified as type I, 27 as type II, and 6 as type III. Regarding HRM parameters, there were statistically significant differences in basal lower esophageal sphincter pressure, 4-second-integrated relaxation pressure, residual upper esophageal sphincter pressure, body amplitude, and maximal intrabolus pressure between subtypes. Regarding therapeutic outcome, type II patients (overall success rate of 80.0%) were more likely to respond than type I (55.2%) or type III (33.2%) patients. Multivariate analysis demonstrated that achalasia subtype (type I vs. III, P = 0.072; type II vs. III, P = 0.005), therapeutic modality (dilation vs. pharmacologic, P = 0.013; laparoscopic Heller's myotomy vs. pharmacologic, P = 0.006), and HRM-measured esophageal length (<27.5 vs. ≥27.5 cm, P = 0.014) are independent predictive factors for therapeutic failure.

Conclusions: Patients with type II achalasia had better treatment outcomes than patients with other achalasia subtypes. Achalasia subtype, therapeutic modality, and esophageal length are independent predictive factors of therapeutic outcome.

1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;

2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;

3Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea;

4Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;

5Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea; and

6Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Address for correspondence: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul 135-720, Korea. E-mail:

The authors have no conflicts of interest to declare.

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