Relationship between esophageal achalasia subtypes and esophageal clearance

• Published in: Esophagus : official journal of the Japan Esophageal Society Vol. 19; no. 3; pp. 500 - 507
• Main Authors: Tsuboi, Kazuto, Yano, Fumiaki, Omura, Nobuo, Hoshino, Masato, Yamamoto, Se-Ryung, Akimoto, Shunsuke, Masuda, Takahiro, Sakashita, Yuki, Fukushima, Naoko, Kashiwagi, Hideyuki, Eto, Ken
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.07.2022; Springer Nature B.V
• Subjects: Barium; Body mass index; Chi-square test; Diagnostic tests; Esophageal diseases; Esophagus; Gastroenterology; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Motility; Original Article; Pathology; Surgical Oncology; Thoracic Surgery; Esophageal clearance; Timed barium esophagogram; Esophageal achalasia; Achalasia subtype; High-resolution manometry
• ISSN: 1612-9059; 1612-9067
• DOI: 10.1007/s10388-022-00910-z

Background The diagnosis and pathological evaluation of esophageal achalasia have been improved dramatically by the development of high-resolution manometry. It is currently known to be divided into three subtypes. However, the differences between subtypes in terms of esophageal clearance remain unclear. Aims To compare the pathology of subtypes in patients with esophageal achalasia from the perspective of esophageal clearance. Methods We classified the patients diagnosed with esophageal achalasia into three subtypes based on the high-resolution manometry findings and compared the patient background, esophagography findings, esophageal manometry findings, timed barium esophagogram (TBE) findings, and their symptoms. We also calculated the esophageal clearance rate from TBE to investigate the relationship with the subtypes. Results There were 71 cases of Type I, 140 cases of Type II, and 10 cases of Type III. No differences by subtype were found in patient background or symptoms. Regarding the esophageal manometry findings, the integrated relaxation pressure was high in Type II ( p  = 0.0006). The esophagography revealed a mild degree of esophageal flexion in Type III ( p  = 0.0022) and a high degree of esophageal dilation in Type I and II ( p  = 0.0227). The esophageal clearance rate in descending order was: Type III, II, and I (height: p  = 0.0302, width: p  = 0.0008). Conclusions The subtypes by high-resolution manometry diagnosis had an association with the esophagography findings and best reflected the esophageal clearance, with no correlation to the patient backgrounds and symptoms.