Achalasia classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Achalasia}} | {{Achalasia}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:'''[[User:Rim Halaby|Rim Halaby]] | {{CMG}}; '''Associate Editor(s)-In-Chief:'''[[User:Rim Halaby|Rim Halaby]], {{TS}}, {{AY}} | ||
==Overview== | ==Overview== | ||
Achalasia can be classified according to the pattern of [[Peristalsis|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== | ==Classification== | ||
===Chicago Classification by High-Resolution Manometry=== | ===Chicago Classification of Achalasia by High-Resolution Manometry=== | ||
====Type I==== | ====Type I==== | ||
Type I achalasia is associated with | * Type I achalasia is associated with no evidence of esophageal pressurization. | ||
* Integrated relaxation pressure (IRP)>10 mmHg distinguishes type 1 achalasia from absent peristalsis.<ref name="pmid22716041">{{cite journal| author=Lin Z, Kahrilas PJ, Roman S, Boris L, Carlson D, Pandolfino JE| title=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. | journal=Neurogastroenterol Motil | year= 2012 | volume= 24 | issue= 8 | pages= e356-63 | pmid=22716041 | doi=10.1111/j.1365-2982.2012.01952.x | pmc=PMC3616504 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22716041 }} </ref> | |||
====Type II==== | ====Type II==== | ||
Type II achalasia is associated with esophageal compression. This type of achalasia is most likely to respond to therapy. | * 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==== | ||
Type III achalasia is associated with spasm. It carries a negative predictive response to therapy. <ref name="pmid18722376">{{cite journal| author=Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ| title=Achalasia: a new clinically relevant classification by high-resolution manometry. | journal=Gastroenterology | year= 2008 | volume= 135 | issue= 5 | pages= 1526-33 | pmid=18722376 | doi=10.1053/j.gastro.2008.07.022 | pmc=PMC2894987 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18722376 }} </ref><ref name="pmid22938702">{{cite journal| author=Roman S, Zerbib F, Quenehervé L, Clermidy H, Varannes SB, Mion F| title=The Chicago classification for achalasia in a French multicentric cohort. | journal=Dig Liver Dis | year= 2012 | volume= 44 | issue= 12 | pages= 976-80 | pmid=22938702 | doi=10.1016/j.dld.2012.07.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22938702 }} </ref> | * Type III achalasia is associated with 2 or more spastic contractions (spastic achalasia). | ||
* IRP>17 mmHg distinguishes type III achalasia from [[Esophageal spasm|difuse esophageal spasm]].<ref name="pmid22716041">{{cite journal| author=Lin Z, Kahrilas PJ, Roman S, Boris L, Carlson D, Pandolfino JE| title=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. | journal=Neurogastroenterol Motil | year= 2012 | volume= 24 | issue= 8 | pages= e356-63 | pmid=22716041 | doi=10.1111/j.1365-2982.2012.01952.x | pmc=PMC3616504 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22716041 }} </ref> | |||
* It carries a negative predictive response to therapy. <ref name="pmid18722376">{{cite journal| author=Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ| title=Achalasia: a new clinically relevant classification by high-resolution manometry. | journal=Gastroenterology | year= 2008 | volume= 135 | issue= 5 | pages= 1526-33 | pmid=18722376 | doi=10.1053/j.gastro.2008.07.022 | pmc=PMC2894987 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18722376 }} </ref><ref name="pmid22938702">{{cite journal| author=Roman S, Zerbib F, Quenehervé L, Clermidy H, Varannes SB, Mion F| title=The Chicago classification for achalasia in a French multicentric cohort. | journal=Dig Liver Dis | year= 2012 | volume= 44 | issue= 12 | pages= 976-80 | pmid=22938702 | doi=10.1016/j.dld.2012.07.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22938702 }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | [[Category:Gastroenterology]] | ||
[[Category:Otolaryngology]] | |||
Latest revision as of 15:43, 6 November 2017
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Achalasia Microchapters |
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Achalasia classification On the Web |
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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.