Fig. 1. Achalasia subtypes by high resolution manometry. (A) Type I (classic achalasia) - there is no significant pressurization within the esophageal body (all dark blue) and impaired lower esophageal sphincter (LES) relaxation (IRP = 42 mmHg). (B) Type II (achalasia with compression) - water swallows cause rapid pan-esophageal pressurization which may exceed LES pressure, causing the esophagus to empty. (C) Type III (spastic achalasia) - although this is also associated with rapidly propagated pressurization, the pressurization is attributable to an abnormal lumen obliterating contraction. (Modified from: Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High resolution manometry in clinical practice: utilizing pressure topography to classify oeosophageal motility abnormalities. Neurogastroenterol Motil 2009;21:796-806). UES, upper esophageal sphincter; IRP, integrated relaxation pressure; CFV, contractile front velocity.
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