Gut | 2019
IDDF2019-ABS-0163\u2005Preliminary results of high-resolution manometry in diagnosis and classification for achalasia
Abstract
Background Achalasia is a rare disease characterized by absent esophageal motility and disorder of lower esophageal sphincter (LES) relaxation. The Chicago Classification, version 3.0 presents the diagnostic criteria for achalasia using high-resolution manometry (HRM) as well as categorizes this disease into three types with different esophageal motility patterns. Methods A case-series study was conducted at the Institute of Gastroenterology and Hepatology on patients suspected achalasia on upper endoscopy or esophageal barium X-ray. Symptom severity was evaluated by the Eckardt score before and after treatment. Achalasia was diagnosed and classified by HRM using the Chicago Classification version 3.0. Results From April to December 2018, we recruited 20 patients (7 males and 13 females; the mean age were 35.9 ± 15.4). There were 4 patients (20%) diagnosed with absent contractility on HRM. In 16 achalasia confirmed patients, the percentage of type I, II, and III was 12.5%, 75%, and 12.5%, respectively. The mean Eckardt score before treatment was 6.6 ± 2.6 and there was no difference between achalasia and absent contractility groups. The integrated relaxation pressure within 4s (IRP4s) in achalasia group was high with the mean value being 24.6 ± 6.3 mmHg and there was no difference among three types. There was a significant improvement of clinical symptoms with pre and post-treatment Eckardt score being 6.8 ± 2.8 and 2.1 ± 1.9, respectively (p < 0.05). In 2 cases after surgery and balloon dilation, the LES pressure was normal but absent contractility and distal esophageal spasm were present on HRM. Conclusions High-resolution manometry is a valuable exploratory test for definitive diagnosis, classification as well as follow-up after treatment on achalasia patients.