title: Clinical, endoscopic, and radiologic features of three subtypes of achalasia, classified using high-resolution manometry.
abstract: OBJECTIVE
  High-resolution manometry (HRM) has improved the accuracy of manometry in detecting achalasia and determining its subtypes. However, the correlation of achalasia subtypes with clinical, endoscopic, and radiologic findings has not been assessed. We aimed to evaluate and compare the clinical, endoscopic, and fluoroscopy findings associated with three subtypes of achalasia using HRM.
  
  
  METHODS
  The retrospective clinical data, HRM, endoscopy, and radiologic findings were obtained from the medical records of untreated achalasia patients.
  
  
  RESULTS
  From 2011 to 2013, 374 patients underwent HRM. Fifty-two patients (14%) were diagnosed with achalasia, but only 32 (8.5%) of these patients had not received treatment and were therefore included in this study. The endoscopy results were normal in 28% of the patients, and a barium swallow was inconclusive in 31% of the achalasia patients. Ten patients (31%) were classified as having type I achalasia, 17 (53%) were classified as type II, and 5 (16%) were classified as type III. Among the three subtypes, type I patients were on average the youngest and had the longest history of dysphagia, mildest chest pain, most significant weight loss, and most dilated esophagus with residual food. Chest pain was most common in type III patients, and frequently had normal fluoroscopic and endoscopic results.
  
  
  CONCLUSIONS
  The clinical, radiologic, and endoscopic findings were not significantly different between patients with type I and type II untreated achalasia. Type III patients had the most severe symptoms and were the most difficult to diagnose based on varied clinical, radiologic, and endoscopic findings.
authors.affiliation: Section of Gastroenterology, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Mohammed Q
authors.initials: MQ
authors.lastname: Khan
authors.forename: Abdullah
authors.initials: A
authors.lastname: AlQaraawi
authors.forename: Fahad
authors.initials: F
authors.lastname: Al-Sohaibani
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Kahtani
authors.forename: Hamad I
authors.initials: HI
authors.lastname: Al-Ashgar
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004931:Esophageal Achalasia / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies