From the Guidelines
The three types of achalasia are Type I, Type II, and Type III, which are classified based on esophageal pressure patterns observed during high-resolution manometry, as defined by the most recent study 1.
Classification of Achalasia
The classification of achalasia into these three types is crucial for determining the best course of treatment, as each type responds differently to various interventions.
- Type I (classic achalasia) features minimal esophageal pressurization with complete absence of peristalsis.
- Type II (with compression) shows panesophageal pressurization with no normal peristalsis, creating pressure that builds up in the esophagus.
- Type III (spastic achalasia) is characterized by premature or spastic contractions in at least 20% of swallows, along with impaired lower esophageal sphincter relaxation.
Importance of Classification for Treatment
This classification is important for treatment decisions, as Type II generally responds best to interventions like pneumatic dilation or surgery, while Type III may be more challenging to treat, with POEM being the preferred treatment option 1. All types share the fundamental problem of impaired relaxation of the lower esophageal sphincter and absence of normal peristalsis, leading to symptoms such as dysphagia, regurgitation, chest pain, and weight loss.
Treatment Approaches
Treatment approaches include medications, endoscopic procedures, or surgical interventions depending on the specific type and severity, with POEM, LHM, and PD being effective therapies for type I and type II achalasia, and POEM being the preferred treatment for type III achalasia 1.
From the Research
Types of Achalasia
The three types of achalasia are:
- Type I: characterized by minimal esophageal pressurization, also known as classic achalasia 2
- Type II: characterized by esophageal compression, with increased isobaric panesophageal pressure 2, 3
- Type III: characterized by spasm, with distal esophageal spastic non-isobaric contractions 2, 3
Key Characteristics of Each Type
Some key characteristics of each type include:
- Type I: patients are typically younger, with increased vomiting severity 3
- Type II: patients have a greater maximum esophageal diameter compared to Type III 3
- Type III: patients have a lower response rate to treatment compared to Type II 4, 5, 2
Treatment Response
The treatment response for each type of achalasia is:
- Type I: responds moderately well to treatment, with a lower response rate compared to Type II 4, 5, 2
- Type II: responds best to treatment, with a high response rate to pneumatic dilation, Heller myotomy, and other therapies 4, 5, 2
- Type III: responds poorly to treatment, with a lower response rate compared to Type II, but may respond better to laparoscopic Heller myotomy 4, 5, 2