Can the upper esophageal sphincter contractile integral help classify achalasia?

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Tools

Background:

• High-resolution manometry (HRM) in achalasia reveals upper esophageal sphincter (UES) dysfunction.
• The UES contractile integral (UES-CI) may help interpret achalasia subtypes per Chicago Classification v3.0.

Purpose of the Study:

• To evaluate the UES contractile integral (UES-CI) in achalasia subtypes.
• To determine if UES-CI can differentiate between achalasia types.

Main Methods:

• Patients classified into achalasia subtypes using HRM.
• Recorded UES length, resting pressure, and residual pressure.
• Calculated UES-CI at rest and corrected for respiration.

Main Results:

• Achalasia type II patients (58.3%) showed significantly higher UES resting pressure and UES-CI compared to types I and III.
• Landmark UES-CI, mean UES-CI, and respiration-corrected UES-CI were elevated in type II achalasia.
• P-values ranged from 0.009 to 0.036 for these significant differences.

Conclusions:

• The UES contractile integral (UES-CI) is introduced as a novel tool for UES manometric evaluation in achalasia.
• Elevated UES resting pressure and UES-CI in achalasia type II may indicate a protective mechanism against aspiration.
• Further clinical correlation is needed to validate these findings.