Achalasia subtypes

 Q: According to Chicago Classification version 3.0 (CC-3), there are how many subtypes of achalasia?

A) One

B) Two

C) Three

D) Four

E) Five

Answer: C

Chicago Classification version 3.0 (CC-3) divides achalasia into three subtypes. Knowing these subtypes are important as management is different for each subtype. 

Type I is called classic achalasia. Clinically in this subtype, there is no significant change in esophageal pressurization due to swallowing. It has 100% failed peristalsis as indicated by a distal contractile integral (DCI) of less than 100 mmHg. 

In type Type II there is simultaneous pressurization which spans the entire esophagus due to swallowing. In this subtype, there is a 100% failed peristalsis and pan-esophageal pressurization in more than/equal to 20% of cases. 

Type III is called spastic achalasia. In this subtype, swallowing results in spasmatic and premature contraction. In this subtype, there is no normal peristalsis and premature (spastic) contractions is seen in more than/equal to 20% of swallows. 

 #surgical-critical-care 

 References:

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1. Kahrilas PJ, Bredenoord AJ, Fox M, et al. International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–174.

2. Patel DA, Lappas BM, Vaezi MF. An Overview of Achalasia and Its Subtypes. Gastroenterol Hepatol (N Y). 2017;13(7):411-421.