POEM · Heller · PD
POEM and Heller are strong definitive options; pneumatic dilation may also be considered in selected patients.
CHICAGO CLASSIFICATION v4.0
Achalasia Types: Type I, II and III
High-resolution manometry separates achalasia into three subtypes. This classification can matter when choosing treatment.
Editorial draft · physician review required before publicationImportant 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
This website is for health education and does not replace diagnosis or individual treatment advice. Seek local emergency care for urgent symptoms.