Timed barium esophagram in achalasia types

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Imaging

Background:

• The relationship between timed barium esophagram (TBE) findings and high-resolution manometry (HRM) achalasia types remains unclear.
• Understanding these correlations is crucial for accurate diagnosis and treatment planning.

Purpose of the Study:

• To correlate preoperative TBE and HRM measurements in achalasia types.
• To relate these findings to patient symptoms and prior treatments.

Main Methods:

• 248 achalasia patients underwent preoperative TBE and HRM before Heller myotomy.
• TBE parameters (height, width, volume remaining) and HRM parameters (lower esophageal sphincter pressure, integrated relaxation pressure, esophageal body contraction amplitude) were analyzed.
• Achalasia was classified into types I, II, and III based on HRM.

Main Results:

• TBE height at 5 minutes was significantly different across achalasia types (I/II > III).
• TBE width at 5 minutes was widest in type I, narrower in type II, and narrowest in type III (P < 0.001).
• Poorer emptying was observed in types I and II compared to type III, with increasing TBE width correlating with disease severity.

Conclusions:

• TBE and HRM measurements are correlated in achalasia, but show a wide range of values.
• A combination of TBE and HRM provides a comprehensive characterization of achalasia morphology and dysfunction.
• Prior treatment influenced emptying and integrated relaxation pressure but symptoms showed poor correlation with TBE/HRM.