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Review
. 2021 May;9(10):906.
doi: 10.21037/atm.2020.03.149.

Manometric pattern progression in esophageal achalasia in the era of high-resolution manometry

Renato Salvador  1 , Mario Costantini  1 , Salvatore Tolone  2 , Pietro Familiari  3 , Ermenegildo Galliani  4 , Bastianello Germanà  4 , Edoardo Savarino  1 , Stefano Merigliano  1 , Michele Valmasoni  1
Affiliations
Review

Manometric pattern progression in esophageal achalasia in the era of high-resolution manometry

Renato Salvador et al. Ann Transl Med. 2021 May.

Abstract

Esophageal manometry represents the gold standard technique for the diagnosis of esophageal achalasia because it can detect both the lack of lower esophageal sphincter (LES) relaxation and abnormal peristalsis. From the manometric standpoint, cases of achalasia can be segregated on the grounds of three clinically relevant patterns according to the Chicago Classification v3.0. It is currently unclear whether they represent distinct entities or are part of a disease continuum with the possibility of transition from a pattern to another one. The four cases described in the present report could provide further insights on this topic because the manometric pattern changed from type III to type II in all patients-without any invasive treatment. The cases described here support the hypothesis that the different manometric patterns of achalasia represent different stages in the evolution of the same disease, type III being the early stage, type II an intermediate stage, and type I probably the end stage of achalasia.

Keywords: Achalasia; Padova theory; manometric pattern.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm.2020.03.149). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The Classification of esophageal motility disorders. IRP, integrated relaxation pressure; ULN, upper limit of normal; PEP, panesophageal pressurization; DL, distal latency; EGJ, esophageal-gastric-junction; DES, diffuse esophageal spasm; DCI, distal contractile integral.
Figure 2
Figure 2
The radiological classification of esophageal achalasia.
Figure 3
Figure 3
Case#2. (A) First barium swallow showing no dilation of the esophagus and a normal transit through the cardia; (B) the HRM study showed an Outflow obstruction with normal peristalsis. HRM, high-resolution manometry.
Figure 4
Figure 4
Case #2. (A) Second barium swallow (3 years later) showing a slow transit of the barium to the cardia (“bird beak” sign); (B) the HRM picture reveled a pattern II achalasia. HRM, high-resolution manometry.
Figure 5
Figure 5
Case #4. (A) First barium swallow showing a slow transit to the cardia with a radiological grade I achalasia; (B) the HRM showed a pattern III achalasia. HRM, high-resolution manometry.
Figure 6
Figure 6
Case #4. (A) Second barium swallow (3 years later) showing a radiological grade II achalasia; (B) HRM: pattern II achalasia. HRM, high-resolution manometry.
See this image and copyright information in PMC

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