Chicago classification of Achalasia

Here I am discussing the Chicago classification and its clinical significance


This is based on high resolution manometry (HRM) 

Manometry evaluates the swallowing response, and weather the LES sphincter relaxation is absent or incomplete.

There are three types of Achalasia and all have incomplete LES relaxation

Type I - Body - Aperistalsis  and no pressurization

Type II Body - aperistalsis and panesophageal pressurization 

Type III - Spastic contractions and distal contractility integral (DCI) over 450 mm HG

 Type 2 achalasia had the best positive response to treatment, and type 3 the least favorable response to treatment.

The best initial treatment option for types 1 and 2 are conservative measures such as pneumatic dilatation and surgical myotomy,

while type 3 achalasia appears to respond better to initial treatment with peroral endoscopic myomectomy