POEM · Heller · PD
POEM and Heller are strong definitive options; pneumatic dilation may also be considered in selected patients.
CHICAGO CLASSIFICATION v4.0
Ахалазия типов I, II и III
Манометрия высокого разрешения выделяет три подтипа, которые могут влиять на выбор лечения.
Редакционный черновик · требуется врачебная проверка перед публикациейImportant 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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