Achalasia cardia subtyping by high-resolution manometry predicts the therapeutic outcome of pneumatic balloon dilatation

Nitesh Pratap, Rakesh Kalapala, Santosh Darisetty, Nitin Joshi, Mohan Ramchandani, Rupa Banerjee, Sandeep Lakhtakia, Rajesh Gupta, Manu Tandan, G V Rao, D Nageshwar Reddy, Nitesh Pratap, Rakesh Kalapala, Santosh Darisetty, Nitin Joshi, Mohan Ramchandani, Rupa Banerjee, Sandeep Lakhtakia, Rajesh Gupta, Manu Tandan, G V Rao, D Nageshwar Reddy

Abstract

Background/aims: High-resolution manometry (HRM) with pressure topography is used to subtype achalasia cardia, which has therapeutic implications. The aim of this study was to compare the clinical characteristics, manometric variables and treatment outcomes among the achalasia subtypes based on the HRM findings.

Methods: The patients who underwent HRM at the Asian Institute of Gastroenterology, Hyderabad between January 2008 and January 2009 were enrolled. The patients with achalasia were categorized into 3 subtypes: type I - achalasia with minimum esophageal pressurization, type II - achalasia with esophageal compression and type III - achalasia with spasm. The clinical and manometric variables and treatment outcomes were compared.

Results: Eighty-nine out of the 900 patients who underwent HRM were diagnosed as achalasia cardia. Fifty-one patients with a minimum follow-up period of 6 months were included. Types I and II achalasia were diagnosed in 24 patients each and 3 patients were diagnosed as type III achalasia. Dysphagia and regurgitation were the main presenting symptoms in patients with types I and II achalasia. Patients with type III achalasia had high basal lower esophageal sphincter pressure and maximal esophageal pressurization when compared to types I and II. Most patients underwent pneumatic dilatation (type I, 22/24; type II, 20/24; type III, 3/3). Patients with type II had the best response to pneumatic dilatation (18/20, 90.0%) compared to types I (14/22, 63.3%) and III (1/3, 33.3%).

Conclusions: The type II achalasia cardia showed the best response to pneumatic dilatation.

Keywords: Balloon dilatation; Esophageal achalasia; Esophageal motility disorder.

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure
Figure
Achalasia subtypes. (A) Type I (classic achalasia), there is no significant pressurization within the body of the esophagus. (B) Type II (achalasia with compression), there is rapid pan-esophageal pressurization. (c) Type III (spastic achalasia), this swallow shows spastic contraction.

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