Question

Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

• A. Type 1 achalasia
• B. Type 2 achalasia
• C. Type 3 achalasia
• D. Jackhammer esophagus

Answer 1

The Correct Option is C

To diagnose esophageal motility disorders, esophageal manometry is often used. Here, the question involves interpreting the manometry results: "panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body." Understanding the characteristics of various esophageal disorders is key to answering the question correctly.

Panesophageal pressurization and high distal contractile pressures are distinctive features seen in different types of esophageal motility disorders. The classifications are:

• Type 1 Achalasia: Characterized by minimal or no pressurization in the esophagus. There is a failure of the lower esophageal sphincter (LES) to relax properly, but with minimal pressure throughout the esophagus.
• Type 2 Achalasia: Presents with panesophageal pressurization, but not at the pressures indicated in the question. Here, the entire esophagus pressurizes uniformly, but the pressures are generally not as high as >450mm Hg.
• Type 3 Achalasia: Known as spastic achalasia, this type involves high amplitude contractions in the distal esophagus. It is characterized by high-pressure peristaltic contractions, akin to those given in the query (>450mm Hg).
• Jackhammer Esophagus: Features the highest esophageal contraction pressures, often exceeding >8000mm Hg. While it involves distal contraction, the pressurization levels here do not match the description.

Thus, the features >450mm Hg distal contractile pressures align primarily with Type 3 Achalasia, which involves excessive contractile pressure in the distal portion of the esophagus indicative of spasmodic activity. Therefore, the diagnosis is Type 3 achalasia.