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. 2017;14(4):275-289.
doi: 10.1007/s10388-017-0589-1. Epub 2017 Sep 5.

Descriptive Rules for Achalasia of the Esophagus, June 2012: 4th Edition

Japan Esophageal Society

Descriptive Rules for Achalasia of the Esophagus, June 2012: 4th Edition

Japan Esophageal Society. Esophagus. 2017.
No abstract available

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Straight (St) type
Fig. 2
Fig. 2
Sigmoid (Sg) type
Fig. 3
Fig. 3
Advanced sigmoid (aSg) type
Fig. 4
Fig. 4
Distinction among the St, Sg, and aSg types
Fig. 5
Fig. 5
Dilatation grading. Grade I d < 3.5 cm, Grade II 3.5 ≤ d < 6.0 cm, Grade III 6.0 cm ≤ d
Fig. 6
Fig. 6
Tortuosity of the upper thoracic esophagus
Fig. 7
Fig. 7
Leftward tortuosity of the esophagus
Fig. 8
Fig. 8
Concurrent epiphrenic diverticulum
Fig. 9
Fig. 9
Endoscopic images. Normal type (a), retained type (b), dilated type (c), and dilated-retained type (d)
Fig. 10
Fig. 10
Endoscopic images of the cardiac portion of the esophagus. Healthy subject (a) and a patient with achalasia (b)
Fig. 11
Fig. 11
Esophageal high-resolution manometry findings of primary peristalsis and lower esophageal sphincter (LES) relaxation after water swallowing in healthy subject. a Manometric instrument: Trace! (Dr. G.S. Hebbard, The Royal Melbourne Hospital, Parkville, Australia). b Manometric instrument: ManoScan 360™ (Sierra Scientific Instruments Inc.)
Fig. 12
Fig. 12
Esophageal high-resolution manometry findings in a patient with achalasia. Manometric instrument: Trace! (Dr. G.S. Hebbard, The Royal Melbourne Hospital, Parkville, Australia)
Fig. 13
Fig. 13
Esophageal manometry findings in a patient with vigorous-type achalasia. Manometric instrument: ManoScan 360™ (Sierra Scientific Instruments Inc.). a Conventional method. b Esophageal high-resolution manometry
Fig. 14
Fig. 14
Histopathologic photomicrographs (Grade II). a Lymphocyte accumulation in Auerbach’s plexus between the hypertrophic inner circular and outer longitudinal muscle layers. b Close-up view of a. Prominent lymphocyte infiltration and fibrosis are evident in Auerbach’s plexus. There is an evident decrease in the number of neuroganglion cells and degeneration of neuroganglion cells
Fig. 15
Fig. 15
Histopathologic photomicrographs (Grade III). a A smaller Auerbach’s plexus is evident in the hypertrophic inner circular and outer longitudinal layers of the tunica muscularis propria. b Close-up view of a. Fibrosis is evident in Auerbach’s plexus. Loss of neuroganglion cells and the nerve fiber network is observed
Fig. 16
Fig. 16
Esophageal manometry in a patient with DES by ManoScan 360™ (Sierra Scientific Instruments Inc.). a Normal peristalsis. b Simultaneous contractions
Fig. 17
Fig. 17
Esophageal manometry in a patient with DES by high-resolution manometry. a Normal peristalsis. b Simultaneous contractions
Fig. 18
Fig. 18
Radiographic appearance in a patient with DES
Fig. 19
Fig. 19
Esophageal high-resolution manometry findings in a patient with nutcracker esophagus. Manometric instrument: Trace ! (Dr. G.S. Hebbard, The Royal Melbourne Hospital, Parkville, Australia)
Fig. 20
Fig. 20
X-ray (a) and endoscopic (b) images of nutcracker esophagus
Fig. 21
Fig. 21
Esophageal manometric features in NEMD. Manometric instrument: INSIGHT (Sandhill Scientific Instruments Inc.)
See this image and copyright information in PMC

References

    1. Iwakiri K, Hoshihara Y, Kawami N, et al. The appearance of rosette-like esophageal folds(“esophageal rosette”)in the lower esophagus after a deep inspiration is a characteristic endoscopic finding of primary achalasia. J Gastroenterol. 2010;45(4):422–425. doi: 10.1007/s00535-009-0179-7. - DOI - PubMed
    1. Camacho-Lobato L, Katz PO, Eveland J, et al. Vigorous achalasia: original description requires minor change. J Clin Gastroenterol. 2001;33(5):375–377. doi: 10.1097/00004836-200111000-00006. - DOI - PubMed
    1. Hongo M. The effects of calcium-antagonists on lower esophageal sphincter pressure-the possibility of application of nifedipine to achalasia. J Jpn Soc Gastroenterol. 1982;79(10):1883–1891. - PubMed
    1. Becker BS, Burakoff R. The effect of verapamil on the lower esophageal sphincter pressure in normal subjects and in achalasia. Am J Gastroenterol. 1983;78(12):773–775. - PubMed
    1. Wong RK, Maydonovitch C, Garcia JE, et al. The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia. J Clin Gastroenterol. 1987;9(4):386–389. doi: 10.1097/00004836-198708000-00006. - DOI - PubMed

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