Treatment of Type III Achalasia with High-Amplitude Spastic Contractions on High-Resolution Manometry

Type III achalasia represents a distinct manometric subtype characterised by high-amplitude spastic contractions in the esophageal body. Its recognition on high-resolution manometry has direct implications for how treatment is selected.

Clinical scenario: Patient with type III achalasia demonstrating high-amplitude spastic contractions in the esophageal body on high-resolution manometry. Three achalasia subtypes are defined by high-resolution manometry findings: type I (low intraesophageal pressure), type II (pan-esophageal pressurisation), and type III (high-amplitude spastic contractions) — each with distinct therapeutic implications.

Treatment approach

For this manometric subtype, an endoscopic myotomy technique is the preferred intervention. The full structured regimen — including procedural details, patient selection criteria, and follow-up parameters — is available via the link below.

Treatment success is assessed using the Eckardt score, with a target of ≤ 3 defining clinical success.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.gie.2019.04.231

We suggest POEM as the preferred treatment for management of patients with type III achalasia.

Three achalasia subtypes have been defined based on the high-resolution manometry findings in the esophageal body: type I or classic achalasia with low intraesophageal pressure, type II with pan-esophageal pressurization, and type III with high-amplitude spastic contractions.

The Eckardt score is based on the summation of 4 symptoms (dysphagia, regurgitation, chest pain, weight loss) that are graded according to severity, and treatment success is defined as a score ≤ 3.

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