Chicago v4.0 definition
Type III requires an abnormal median IRP, premature/spastic contractions in at least 20% of swallows and no normal peristalsis.
Why is it called spastic?
Contractions begin too early and lose the normal sequential pattern. Chest pain can be prominent, but symptoms alone do not define the subtype.
Why ask about opioids?
Opioid exposure can alter oesophageal motility and may be associated with Type III or EGJOO-like spastic patterns. Medication history matters when interpreting HRM.
Why can myotomy length matter?
Spasm may extend above the LES, so treatment may need to cover a longer oesophageal segment. POEM allows the myotomy to be tailored proximally.
POEM or Heller?
The 2025 SAGES update conditionally favours POEM over Heller myotomy for adult Type III achalasia, while anatomy, previous therapy, reflux risk and centre expertise still matter.
Tedavi sonrası reflü neden ayrıca konuşulmalı?
POEM fundoplikasyon içermediği için işlem sonrası gastroözofageal reflü objektif olarak gelişebilir. Semptom olsun veya olmasın, merkez protokolüne göre PPI, endoskopi veya reflü testi gibi takip araçları gündeme gelebilir.