Comparison of Achalasia Classification Schemes to Predict Treatment Outcomes.

Area of Science:

• Gastroenterology
• Esophageal Disorders
• Diagnostic Imaging

Background:

• Existing achalasia classifications include Chicago Classification (high-resolution manometry) and Japanese Esophageal Society, Italian, or Brazilian (esophagram-based).
• These schemes aim to stratify disease severity and predict treatment response.

Purpose of the Study:

• To compare the predictive accuracy of different achalasia classification systems for treatment outcomes.
• To determine if high-resolution manometry or esophagram-based classifications are superior for predicting achalasia treatment success.

Main Methods:

• A cohort of 222 adult achalasia patients underwent pretreatment high-resolution manometry (HRM) and esophagram.
• Chicago Classification and Japanese Esophageal Society (JES) subtypes were determined by HRM; Italian and Brazilian classifications by esophagram.
• Treatment outcomes were assessed using the Eckardt symptom score and timed barium esophagram (TBE).

Main Results:

• The Chicago Classification significantly predicted symptomatic outcomes (p=0.003-0.007), while JES, Italian, and Brazilian classifications did not.
• All four classifications predicted radiographic outcomes, with JES showing the best model fit (lowest AIC).
• Type III achalasia (Chicago) had poor symptomatic outcomes; advanced esophagram stages (JES-C, Italian IV, Brazilian 2-3) correlated with worse radiographic outcomes.

Conclusions:

• Both HRM and esophagram classifications predict achalasia treatment outcomes, but with differing strengths.
• HRM-based Chicago Classification is superior for predicting symptomatic outcomes.
• Esophagram-based classifications (JES, Italian, Brazilian) better predict objective radiographic outcomes.
• Combining both HRM and esophagram data may improve prognostication for achalasia patients.