POEM · Heller · PD
POEM and Heller are strong definitive options; pneumatic dilation may also be considered in selected patients.
CHICAGO CLASSIFICATION v4.0
Achalasie Typ I, II und III
Die hochauflösende Manometrie unterscheidet drei Subtypen, die die Therapieentscheidung beeinflussen können.
Redaktioneller Entwurf · ärztliche Prüfung vor Veröffentlichung erforderlichImportant distinction
Type I, II and III are not diagnosed from symptoms. Subtype is defined by high-resolution manometry (HRM).
TYPE I
Classic achalasia
Abnormal median IRP + 100% failed peristalsis, without the prominent panesophageal pressurisation of Type II.
Full Type I guide →
TYPE II
Panesophageal pressurisation
Abnormal median IRP + 100% failed peristalsis + panesophageal pressurisation in ≥20% of swallows.
Full Type II guide →
TYPE III
Spastic achalasia
Abnormal median IRP + premature/spastic contractions in ≥20% of swallows; no normal peristalsis.
Full Type III guide →WHY DOES SUBTYPE MATTER FOR TREATMENT?
Subtype does not determine treatment by itself, but it is an important part of the decision.
POEM · Heller · PD
Several effective options exist; age, anatomy, reflux priorities and centre expertise guide individualisation.
POEM often stands out
Because the spastic segment may require a longer myotomy, current SAGES guidance favours POEM.
Medical safety note
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