Achalasia and its subtypes: a Moroccan cohort in Ibn Sina Hospital, Rabat

ABSTRACT

Introduction: achalasia is an esophageal motility disorder, characterized by irregular peristalsis and inadequate relaxation of the lower esophageal sphincter, typically manifests with dysphagia as its primary symptom. The advent of high-resolution manometry (HRM) has transformed our comprehension of achalasia. It has delineated three distinct subtypes based on variations in pressurization and contractions, contributing significantly to the understanding of this condition. This study aimed to describe and compare clinically and manometrically the patients suffering from the different subtypes of achalasia. Methods: it is a retrospective single-center study including all patients with achalasia diagnosed by high-resolution manometry (HRM) between April 2018 and January 2023. The diagnosis was retained based on the latest Chicago 3.0 classification. Results: out of 103 patients, 25.2% (n=26) had type I achalasia, 66.9% (n=69) type II, and 7.8% (n=8) type III. Patients with type I and II achalasia were younger than patients with type III achalasia (mean age 43.2 years vs. 55.6 years, P=0.0053). A female predominance was found in type I achalasia and a male predominance in type III. The most frequent symptoms were dysphagia (found in all our patients). At HRM, all our patients had a pathological IRP with a mean of 26.95 mmHg for the 3 types of achalasia. Resting IBS pressures were higher in patients with type III achalasia compared to types I and II (35.28 mmHg vs 32.7 mmHg and 31.04 mmHg, P=0.40). Conclusion: achalasia is one of the most studied esophageal motility disorders. Tools such as HRM have permitted us not only to identify achalasia early but also to define different subtypes, which can have therapeutic implications.