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Background: Idiopatic achalasia (IA) and Chagas disease esophagopathy (CDE) share several similarities; however, some differences between the 2 diseases have been noticed. The comparison between IA and CDE is important to evaluate if treatment options and their results can be accepted universally. High-resolution manometry (HRM) has proved a better diagnostic tool compared to conventional manometry. The study of IA patients with the aid of HRM allowed the creation of new classifications of the disease with apparent correlation with treatment outcomes, as proposed by the Chicago and Rochester groups. The clinical application of HRM parameters in patients with CDE is still elusive. This study aims to evaluate HRM classifications for idiopathic achalasia in patients with CDE.
Methods: We studied 86 patients with achalasia: 45 patients with CDE (54% females, mean age 55.8 ± 14.7 years) and 41 patients with IA (58% females, mean age 49.0 ± 19 5 years). All patients underwent a HRM when Chicago and Rochester classifications for achalasia were applied and a barium esophagram to measure esophageal dilatation.
Results: The Chicago classification was present in IA: Chicago I: 32%, Chicago II: 66% and Chicago III: 2%; In CDE: Chicago I: 49%, Chicago II: 51% and Chicago III: 0% (p= 0.178). The Rochester classification was present in IA: Rochester I: 2%, Rochester II: 66% and Rochester III: 32%; In CDE: Rochester I: 0%, Rochester II: 51% and Rochester III: 49% (p= 0.178). CDE patients had more pronounced degrees of esophageal dilatation (p<0.0001). The degree of esophageal dilatation did not correlate with neither classification (p=0.2); however, an indirect correlation between esophageal body pressure amplitude and the degree of esophageal dilatation was noticed (p=0.001). In 9 (10%) patients the HRM pattern changed during the test from Chicago I to II.
Conclusion: Our results show that: (a) HRM classifications for IA can be applied in patients with CDE and (b) HRM classifications did not correlate with the degree of esophageal dilatation. The secondary findings of our study suggest that HRM classifications may reflect esophageal repletion and pressurization instead of muscular contraction. The correlation between manometric findings and treatment outcomes for CDE needs to be answered in a near future.