Year 2024 / Volume 116 / Number 11
Original
Achalasia: diagnostic delay and manometric characteristics with high-resolution solid-state and perfusion equipment

590-598

DOI: 10.17235/reed.2024.10181/2023

María Adela López Sánchez, Constanza Ciriza de los Ríos, Cecilio Santander,

Abstract
Introduction: the early diagnosis of achalasia requires a high degree of clinical suspicion, and delays in diagnosis are frequent. High-resolution esophageal manometry (HRM) is the gold standard for its diagnostic confirmation. There are two HRM systems, perfusion and solid-state, which allow its classification into three subtypes: I, or classical; II, or with pan-esophageal pressurization; and III, or spastic. Objective: to determine the clinical and manometric characteristics of the three subtypes with high-resolution perfusion and solid-state equipment and the time of evolution until diagnosis. Methods: this was a multicenter, observational, retrospective study of patients from the INTEGRA database of the Spanish Association of Neurogastroenterology and Motility who were diagnosed with primary achalasia confirmed by HRM, who fell under the Chicago Classification v3.0, and who had not been treated. Results: the study included 110 patients (subtype I, n = 14; subtype II, n = 73; subtype III, n = 23). The HRM equipment was perfusion for 49 and solid-state for 61. The mean age was 61.8 ± 14 years (age range 44-81), the age was lower in subtype II, and sex distribution was similar. The time of clinical evolution until diagnosis was > 12 months (51.6 %), subtype II being the one that was diagnosed earlier and the most often (66.3 %). Dysphagia was the most frequent symptom (90.5 %). According to the comparative analysis by high-resolution perfusion and solid-state esophageal manometry equipment, the baseline pressure of the lower esophageal sphincter was higher in the solid-state esophagus, but the difference was not statistically significant. The median integrated relaxation pressure at four seconds (IRP4) was similar (21 mmHg) between the perfusion and solid-state measurements. We describe the ranges of IRP4 in achalasia patients with both systems and confirm the possibility of achalasia even when IRP4 is within the normal range. Conclusions: achalasia in our environment has a significant diagnostic delay. No significant differences were observed in the esophagogastric junction between the two groups diagnosed with perfusion and solid-state equipment.
Lay Summary
The early diagnosis of achalasia requires a high degree of clinical suspicion, and delays in diagnosis are frequent. High-resolution oesophageal manometry (HRM) is the gold standard for its diagnostic confirmation. There are two HRM systems, perfusion and solid-state, which allow its classification into three subtypes: I, or classical; II, or with pan-oesophageal pressurization; and III, or spastic. The purpose of our study was to determine the clinical and manometric characteristics of the three subtypes with high resolution perfusion and solid-state equipment and the time of evolution until diagnosis. A multicentre, observational and retrospective study was carried out with patients from the INTEGRA database of the Spanish Association of Neurogastroenterology and Motility who were diagnosed with primary achalasia confirmed by HRM, who fell under the Chicago Classification v3.0, and who had not been treated. 110 patients were included, 14 of them with achalasia subtype I, 73 with subtype II and 23 with subtype III, confirmed by HRM perfusion system in 49 patients and by HRM solid-state system in 61 patients. The results determined that the mean age was 61.8 ± 14 years, with an age range of 44-81, being lower in subtype II, and the gender distribution was similar. The time of clinical evolution until diagnosis was > 12 months (51.6%), subtype II being the one that was diagnosed earlier and the most often (66.3%). Dysphagia was the most frequent symptom (90.5%). According to the comparative analysis by high-resolution perfusion and solid-state oesophageal manometry equipment, the baseline pressure of the lower oesophageal sphincter was higher in the solid-state oesophagus, but the difference was not statistically significant. The median integrated relaxation pressure at 4 seconds (IRP4) was similar (21 mmHg) with both HRM equipments. Our study provides the ranges of IRP4 in achalasia patients with both systems and confirm the possibility of achalasia even when IRP4 is within the normal range, concluding that achalasia in our environment has a significant diagnostic delay, without observing significant differences in the oesophagogastric junction assessment regardless of using perfusion or solid-state equipment.
Share Button
New comment
Comments
No comments for this article
References
1. Zaninotto G, Bennett C, Boeckxstaens G, et al. The 2018 ISDE Achalasia guidelines. Dis Esophagus. 2018;
2. Vaezi MF, Pandolfino JE, Yadlapati RH, et al. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393–411.
3. Oude Nijhuis RAB, Zaninotto G, Roman S, et al. European Guideline on Achalasia – UEG and ESNM recommendations. United Eur Gastroenterol J. 2020;8(1):13– 34.
4. Farell-Rivas J, Soto-Pérez JC, Mata-Quintero CJ, et al. Manejo endoscópico de la acalasia: revisión clínica. Endoscopia. 2014;
5. Orgaz Gallego MP. Achalasia: un trastorno de la motilidad esofágica, no tan raro. Rev Clínica Med Fam. 2009;2(6):305–8.
6. Jung HK, Hong SJ, Lee OY, et al. 2019 Seoul consensus on esophageal Achalasia guidelines. J Neurogastroenterol Motil. 2020;26(2):180–203.
7. Méndez R. Acalasia esofágica (Esophageal achalasia). Rev Médica Sinerg [Internet]. 2018;3(10):3–6. Available from: https://www.medigraphic.com/pdfs/sinergia/rms-2018/rms1810a.pdf
8. Burgos-santamaría D, Marinero A, Santander C., et al. Normal values for water- perfused esophageal high-resolution manometry. Rev Esp Enfermedades Dig. 2015;107:354–8.
9. Botoman VA. Functional assessment of achalasia. J Xiangya Med. 2019;4(April):21037.
10. Taft TH, Carlson DA, Triggs J, et al. Symptom score as a measure of Achalasia severity. Neurogastroenterol Motil. 2018;30(6):1–14.
11. Jain M. Achalasia cardia: A diagnosis often delayed! Indian J Gastroenterol. 2019;38(2):183–4.
12. Eckardt VF, Köhne U, Junginger T, et al. Risk factors for diagnostic delay in achalasia. Dig Dis Sci. 1997;42(3):580–5.
13. Jeon HH, Kim JH, Youn YH, et al. Clinical characteristics of patients with untreated achalasia. J Neurogastroenterol Motil. 2017;23(3):378–84.
14. Niebisch S, Hadzijusufovic E, Mehdorn M, et al. Achalasia—an unnecessary long way to diagnosis. Dis Esophagus. 2017;30(5):1–6.
15. Echavarría Echavarría R. Frecuencia de acalasia en pacientes que se someten a
Manometría de alta resolución en el Departamento de Gastroenterología de El Centro de Diagnóstico Medicina Avanzada y Telemedicina (CEDIMAT), 2019- 2021. CEDIMAT. 2021;1–91.
16. Khan MQ, AlQaraawi A, Al-Sohaibani F, et al. Clinical, endoscopic, and radiologic features of three subtypes of achalasia, classified using high-resolution manometry. Saudi J Gastroenterol. 2015;21(3):152–7.
17. Lee JY, Kim N, Kim SE, et al. Clinical characteristics and treatment outcomes of 3 subtypes of achalasia according to the chicago classification in a tertiary institute in Korea. J Neurogastroenterol Motil. 2013;19(4):485–94.
18. A.Meillier, D.Midani, D. Caroline,et al. Diferencias en los subtipos de acalasia basadas en síntomas clínicos, hallazgos radiológicos y puntajes de estasis. Rev Gastroenterol Mex. 2018;83(1):1–2.
19. Tejedor Cerdeña MA. Estudio clínico y molecular de acalasia esofágica. 320503 Gastroenterol. 2011;10.14201/g.
20. Amable Díaz T, Anido Escobar VM, Martínez Leyva L, et al. High-resolution manometry in achalasia of esophagus. Rev Cuba Med Mil. 2021;50(3).
21. Joseph R. Triggs, Dustin A. Carlson, Claire Beveridge, et al. Upright Integrated Relaxation Pressure Facilitates Characterization of Esophagogastric Junction Outflow ObstructionNo Title. Clin Gastroenteroly Hepatol. 2019;17(11): 22(17(11): 2218–2226.e2. doi:10.1016/j.cgh.2019.01.024.).
22. Ciriza-de-los-Ríos C, Canga-Rodríguez-Valcárcel F, Castel-de-Lucas I, et al. Utilidad de la manometría de alta resolución en el diagnóstico de la disrupción de la unión gastroesofágica: Causas que influyen en su disrupción y asociación con reflujo gastroesofágico y alteraciones manométricas. Rev Esp Enfermedades Dig. 2014;106(1):22–9.
23. Cohen DL, Avivi E, Bermont A, et al. Correlation between Lower Esophageal Sphincter Metrics on High-Resolution Manometry and the Clinical Presentation of Patients with Newly Diagnosed Achalasia. Diagnostics. 2023;13(6):4–11.
24. Rogers BD, Rengarajan A, Abrahao L, et al. Esophagogastric junction morphology and contractile integral on high-resolution manometry in asymptomatic healthy volunteers: An international multicenter study. Neurogastroenterol Motil. 2021;33(6).
25. Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144(4):718–25.
Related articles

Letter

A case of achalasia associated with early esophageal cancer

DOI: 10.17235/reed.2024.10177/2023

Letter

When eating becomes a real nightmare

DOI: 10.17235/reed.2023.10025/2023

Letter

Drug-induced sudden dysphagia

DOI: 10.17235/reed.2023.9989/2023

Digestive Diseases Image

Dysphagia secondary to neuroendocrine carcinoma: a rare esophageal tumor

DOI: 10.17235/reed.2023.9951/2023

Digestive Diseases Image

Solid food dysphagia caused by aortic arch malformation compressing the esophagus

DOI: 10.17235/reed.2023.9923/2023

Letter

Esophageal necrosis secondary to thoracic aortic aneurysm

DOI: 10.17235/reed.2023.9580/2023

Digestive Diseases Image

Esophageal lichen planus: an unusual case of dysphagia

DOI: 10.17235/reed.2023.9572/2023

Letter

Large symptomatic esophageal diverticulum

DOI: 10.17235/reed.2023.9518/2023

Digestive Diseases Image

Type II achalasia with post-POEM recovery of esophageal motility

DOI: 10.17235/reed.2023.9420/2022

Digestive Diseases Image

A giant cause of recurrent fever

DOI: 10.17235/reed.2022.9340/2022

Letter

Eagle’s syndrome as a cause of oropharyngeal dysphagia

DOI: 10.17235/reed.2022.9295/2022

Letter

Infection with SARS-CoV-2 as a potential achalasia trigger

DOI: 10.17235/reed.2022.8975/2022

Digestive Diseases Image

Acute respiratory failure secondary to megaesophagus: think beyond COVID-19

DOI: 10.17235/reed.2022.8847/2022

Digestive Diseases Image

Severe drug esophagitis in a patient with achalasia

DOI: 10.17235/reed.2022.8476/2021

Digestive Diseases Image

Severe respiratory failure secondary to megaesophagus due to terminal achalasia

DOI: 10.17235/reed.2020.7672/2020

Original

Implementation of a peroral endoscopic myotomy program

DOI: 10.17235/reed.2020.7116/2020

Letter

Familial dysphagia: eosinophilic esophagitis

DOI: 10.17235/reed.2019.6610/2019

Letter

Hypertensive panesophageal pressurization in type II achalasia

DOI: 10.17235/reed.2019.6414/2019

Letter

Esophageal lichen planus: a rare cause of dysphagia

DOI: 10.17235/reed.2019.6064/2018

Letter

An unexpected cause of dysphagia: pleural mesothelioma

DOI: 10.17235/reed.2019.6024/2018

Letter

Dysphagia lusoria: uncommon cause of dysphagia in children

DOI: 10.17235/reed.2018.5664/2018

Digestive Diseases Image

Dysphagia lusoria: a little-known cause of dysphagia

DOI: 10.17235/reed.2018.5385/2017

Case Report

Peroral endoscopic myotomy in pediatric jackhammer esophagus

DOI: 10.17235/reed.2018.5090/2017

Original

Practical aspects of high resolution esophageal manometry

DOI: 10.17235/reed.2016.4441/2016

Letter to the Editor

Utility of surgical myotomy in the dysphagia due to oculopharyngeal dystrophy

DOI: 10.17235/reed.2016.4266/2016

Citation tools
López Sánchez M, Ciriza de los Ríos C, Santander C. Achalasia: diagnostic delay and manometric characteristics with high-resolution solid-state and perfusion equipment. 10181/2023


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 366 visits.
This article has been downloaded 104 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 17/12/2023

Accepted: 21/05/2024

Online First: 03/07/2024

Published: 11/11/2024

Article revision time: 146 days

Article Online First time: 199 days

Article editing time: 330 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology