Table 2 Achalasia syndromes beyond the CC v3.0

From: Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

CC v3.0 diagnosis

IRP > ULN?

Oesophageal contractility

Notes

Oesophagogastric junction outflow obstruction

Yes

Sufficient peristalsis to exclude type I, II or III achalasia

• Heterogeneous group

• Early or incomplete achalasia

• Can resolve spontaneously

• Recording artefacts

Absent contractility

No

Absent contractility

• Can be achalasia

• Abnormal FLIP distensibility index supports achalasia

• Oesophageal pressurization with swallows or MRS supports achalasia

Distal oesophageal spasm

Yes or no

≥20% premature contractions (DL <4.5s)

Might be spastic achalasia

Jackhammer

Yes or no

≥20% of swallows with DCI >8,000 mmHgscm

Might be spastic achalasia if DL <4.5 s with ≥20% swallows

Opioid effect (not in CC)

Yes

Normal, hypercontractile or premature

Can mimic EGJOO, type III achalasia, DES or jackhammer

Mechanical obstruction (not in CC)

Yes

Absent, normal or hypercontractile

EUS, CT or MRI of the EGJ might clarify the aetiology

  1. CC, Chicago Classification; DCI, distal contractile integral; DES, distal oesophageal spasm; DL, distal latency; EGJ, oesophagogastric junction; EGJOO, EGJ outflow obstruction; EUS, endoscopic ultrasonography; FLIP, functional luminal imaging probe; IRP, integrated relaxation pressure; MRS, multiple repetitive swallows; ULN, upper limit of normal.
PowerPoint slide
Back to article page