Fig. 4. The esophageal high-resolution manometry (HRM), esophagography, and FLIP results of a patient whose diagnosis was changed from IEM by Chicago classification version 3.0 (CC v3.0) to achalasia by CC v4.0. (A) The HRM shows normal integrated rapid pressure (IRP) and 60% ineffective swallows, and rapid drink challenge (RDC) test shows spastic lower esophageal contraction (RDC IRP; 9 mmHg). (B) Esophagography shows delayed and incomplete relaxation of lower esophageal sphincter (LES) with slightly prolonged esophageal emptying time. (C) The distensibility index of the LES was determined to be lower than normal (0.5 mm2/mmHg at 50 mL, 1.8 mm2/mmHg at 60 mL, and 1.9 mm2/mmHg at 70 mL).
© J Neurogastroenterol Motil
