The Chicago classification for achalasia in a French multicentric cohort

Achalasia is divided into 3 subtypes using the Chicago classification for high-resolution manometry. Aim of this study was to apply this classification to a multicentric French cohort of achalasia and to compare clinical and manometric characteristics between the 3 subtypes.

Oesophageal symptoms were collected in a retrospective study of patients diagnosed with achalasia on high-resolution manometry. Manometry data were analyzed with oesophago-gastric junction resting and relaxation pressures, and upper oesophageal sphincter resting pressure. Achalasia was classified according to the Chicago classification.

From 2007 to August 2011, achalasia was diagnosed in 169 patients, 14% classified as type I, 70% as type II and 16% as type III. Type III patients were older than types I and II (62 years vs. 52, p = 0.03). Ninety five percent of patients complained of dysphagia, 16% of chest pain (no difference between the 3 subtypes); 50% of type I patients presented regurgitations compared to 33% of type II and 22% of type III (p = 0.10). Oesophago-gastric junction and upper oesophageal sphincter pressures did not differ between the 3 groups.

Type II was the more prevalent subtype of achalasia in this French multicentre cohort. The older age of patients with type III achalasia suggests a different pathophysiology.