Achalasia classification

	Achalasia Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Achalasia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Achalasia classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Achalasia classification All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Achalasia classification
CDC on Achalasia classification
Achalasia classification in the news
Blogs on Achalasia classification
Directions to Hospitals Treating Achalasia
Risk calculators and risk factors for Achalasia classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:Rim Halaby, Twinkle Singh, M.B.B.S. [2], Ahmed Younes M.B.B.CH [3]

Overview

Achalasia can be classified according to the pattern of abnormal peristalsis into three types. Different types of achalasia are shown to have different responses to therapies with type II having the best prognosis.

Classification

Chicago Classification of Achalasia by High-Resolution Manometry

Type I

Type I achalasia is associated with no evidence of esophageal pressurization.
Integrated relaxation pressure (IRP)>10 mmHg distinguishes type 1 achalasia from absent peristalsis.^[1]

Type II

Type II achalasia is associated with esophageal compression (panesophageal pressurization).
This type of achalasia is most likely to respond to therapy.

Type III

Type III achalasia is associated with 2 or more spastic contractions (spastic achalasia).
IRP>17 mmHg distinguishes type III achalasia from difuse esophageal spasm.^[1]
It carries a negative predictive response to therapy. ^[2]^[3]

References

↑ ^1.0 ^1.1 Lin Z, Kahrilas PJ, Roman S, Boris L, Carlson D, Pandolfino JE (2012). "Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model". Neurogastroenterol Motil. 24 (8): e356–63. doi:10.1111/j.1365-2982.2012.01952.x. PMC 3616504. PMID 22716041.
↑ Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008). "Achalasia: a new clinically relevant classification by high-resolution manometry". Gastroenterology. 135 (5): 1526–33. doi:10.1053/j.gastro.2008.07.022. PMC 2894987. PMID 18722376.
↑ Roman S, Zerbib F, Quenehervé L, Clermidy H, Varannes SB, Mion F (2012). "The Chicago classification for achalasia in a French multicentric cohort". Dig Liver Dis. 44 (12): 976–80. doi:10.1016/j.dld.2012.07.019. PMID 22938702.

[pmid22716041-1] 1.0 ^1.1 Lin Z, Kahrilas PJ, Roman S, Boris L, Carlson D, Pandolfino JE (2012). "Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model". Neurogastroenterol Motil. 24 (8): e356–63. doi:10.1111/j.1365-2982.2012.01952.x. PMC 3616504. PMID 22716041.

[pmid18722376-2] Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008). "Achalasia: a new clinically relevant classification by high-resolution manometry". Gastroenterology. 135 (5): 1526–33. doi:10.1053/j.gastro.2008.07.022. PMC 2894987. PMID 18722376.

[pmid22938702-3] Roman S, Zerbib F, Quenehervé L, Clermidy H, Varannes SB, Mion F (2012). "The Chicago classification for achalasia in a French multicentric cohort". Dig Liver Dis. 44 (12): 976–80. doi:10.1016/j.dld.2012.07.019. PMID 22938702.

[1]

[2]

[3]