Clinical Characteristics and Treatment Outcomes of 3 Subtypes of Achalasia According to the Chicago Classification in a Tertiary Institute in Korea

Abstract

Background/AimsAchalasia is classified into 3 types according to the Chicago classification. The aim of this study was to investigate characteristics and treatment outcomes of 3 achalasia subtypes in Korean patients.MethodsFifty-five patients diagnosed with achalasia based on conventional or high-resolution esophageal manometry were consecutively enrolled. Their clinical characteristics, manometric, endoscopic and esophagographic findings and treatment responses were analyzed among the 3 subtypes of achalasia.ResultsOf 55 patients, 21 (38.2%) patients had type I, 28 (50.9%) patients had type II and 6 (10.9%) patients had type III. The median follow-up period was 22.4 (interquartile range, 3.6-67.4) months. Type III patients were older than type I and II patients (70.0 vs. 46.2 and 47.6 years, P = 0.023). The width of the esophagus in type I patients was wider with more frequent bird's beak appearance on esophagogram than the other 2 types (P = 0.010 and 0.006, respectively). Of the 50 patients who received the evaluation for treatment response at 3 months, 7 patients (36.8% vs. 26.9%) were treated with pneumatic dilatation and 4 patients (21.1% vs. 15.4%) with laparoscopic Heller's myotomy in type I and II groups, respectively. The treatment responses of pneumatic dilatation and Heller's myotomy in type I group were 71.4 and 50.0% and in type II were 85.7 and 75.0%, respectively, and all 5 patients in type III group showed good response to medical therapy.ConclusionsClinical characteristics of 3 achalasia subtypes in Korean patients are consistent with other studies. Treatment outcomes are variable among 3 subtypes.

Effects of Age on Esophageal Motility: Use of High-resolution Esophageal Impedance Manometry

“…[4][5][6] The neural control of gastrointestinal function, including esophageal motility is related to enteric neurons. 7,8 It has been shown that changes in esophageal physiology is associated with loss of esophageal myenteric plexus neurons, which are part of the enteric nervous system (ENS) and lie within the smooth muscle layers of the esophageal wall in the aged population. [9][10][11] In addition, underlying disease (such as diabetes mellitus) conditions which is more prevalent in aged people could cause decrease of esophageal motility.…”

Predictive Factors of Response to Proton Pump Inhibitors in Korean Patients With Gastroesophageal Reflux Disease

“…Patients were performed the 10 swallows comprising 5-mL water at 20-second intervals in order to estimate the basal and residual LES pressure, amplitude and duration of esophageal body contraction. 12 …”

Correlation Between Timed Barium Esophagogram and Esophageal Transit Scintigraphy Results in Achalasia

“…We reported previously that patients with vigorous achalasia had narrower esophageal lumen and shorter transit times than those of classic achalasia group [24]. The relationship between TBE findings and subtypes defined by HRM has not been clearly elucidated [3,20,25,26]. Another paper also reported that the esophageal width of type I and II achalasia patients was larger than that of type III achalasia, which was consistent with our studies, and the report showed a significant correlation between the barium column height and clinical symptom scores after EPD [25].…”