Correlations between Symptoms and High-Resolution Manometry Metrics in Different Types of Achalasia

Achalasia cardia is a rare motility disorder with a gradual onset of varied and subtle symptoms. Dysphagia, regurgitation, retrosternal pain and weight loss are the cardinal symptoms, with retrosternal pain being more frequent in younger patients. The advent of high-resolution manometry (HRM) greatly improved the diagnostic yield for achalasia and has allowed its classification into three subtypes. The aim of our study was to analyse correlations between symptoms and HRM pressure data in the three subtypes of achalasia. Our results showed that dysphagia, retrosternal pain, the integrated relaxation pressure (IRP) and distal esophageal pressure (DEP) changes were all greater in achalasia type II compared to achalasia type I. When analysing the whole group of achalasia patients we found significant correlations between IRP and the dysphagia, regurgitation and pain subscores, but not with the total Eckardt score. In both achalasia types I and II, IRP correlated with retrosternal pain, but not with dysphagia, regurgitation or weight loss. Based on our findings the subtypes of achalasia cannot be differentiated based on symptoms alone.