Chicago v4.0 definition
Conclusive Type I achalasia is defined by an abnormal median IRP and 100% failed peristalsis. Significant panesophageal pressurisation is absent.
What does HRM show?
There is no normal sequential contraction after swallowing, and the EGJ does not relax normally. Pressure generation in the oesophageal body is generally less prominent than in Type II.
Can symptoms identify Type I?
No. Dysphagia, regurgitation, weight loss and chest symptoms overlap among subtypes. HRM—not symptoms—defines the subtype.
What if the result is borderline?
When IRP is borderline or findings change by position, timed barium oesophagram and/or FLIP can provide supportive evidence.
Treatment implications
POEM and Heller myotomy are definitive options; pneumatic dilation may also be considered in selected patients. Current SAGES guidance supports shared decision-making for Types I and II.
Tedaviden sonra yalnız semptom yeterli mi?
Semptom düzelmesi önemlidir ancak nüks veya geçiş sorunu şüphesinde objektif boşalma değerlendirmesi ve gerektiğinde endoskopi/manometri kullanılabilir. Tedavi sonrası reflü ayrıca ele alınmalıdır.