Journal of Gastrointestinal Surgery

, Volume 18, Issue 2, pp 221–225 | Cite as

High-Resolution Manometry Classifications for Idiopathic Achalasia in Patients with Chagas' Disease Esophagopathy

  • Fernando P. P. Vicentine
  • Fernando A. M. Herbella
  • Marco E. Allaix
  • Luciana C. Silva
  • Marco G. Patti
2013 SSAT Plenary Presentation



Idiopathic achalasia (IA) and Chagas' disease esophagopathy (CDE) share several similarities. The comparison between IA and CDE is important to evaluate whether treatment options and their results can be accepted universally. High-resolution manometry (HRM) has proved a better diagnostic tool compared to conventional manometry. This study aims to evaluate HRM classifications for idiopathic achalasia in patients with CDE.


We studied 98 patients: 52 patients with CDE (52 % females, mean age, 57 ± 14 years) and 46 patients with IA (54 % females; mean age 48 ± 19 years). All patients underwent a HRM and barium esophagogram.


The Chicago classification was distributed in IA as Chicago I, 35 %; Chicago II, 63 %; and Chicago III, 2 %, and in CDE as Chicago I, 52 %; Chicago II, 48 %; and Chicago III, 0 % (p = 0.1, 0.1, and 0.5, respectively). All patients had the classic Rochester type. CDE patients had more pronounced degrees of esophageal dilatation (p < 0.002). The degree of esophageal dilatation did not correlate with Chicago classification (p = 0.08). In nine (9 %) patients, the HRM pattern changed during the test from Chicago I to II.


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. 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 the near future.


Esophageal achalasia Manometry Chagas' disease 



Dr. Fernando Vicentine was supported by a grant from the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), a governmental funding agency.


  1. 1.
    Patti MG, Herbella FA. Achalasia and other esophageal motility disorders. J Gastrointest Surg. 2011; 15: 703–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Farrokhi F, Vaezi MF. Idiopathic (primary) achalasia. Orphanet J Rare Dis. 2007; 2:38–45.Google Scholar
  3. 3.
    Dantas RO. Comparação entre acalásia idiopática e acalásia consequente à doença de Chagas: revisão de publicações sobre o tema. Arq Gastroenterol. 2003 Abr/Jun; 40 (2): 126–30.Google Scholar
  4. 4.
    Vicentine FP, Herbella FA, Allaix ME, Silva LC, Patti MG. Comparison of idiopathic achalasia and Chagas' disease esophagopathy at the light of high resolution manometry. Dis Esophagus. 2013; doi: 10.1111/dote.12098 PubMedGoogle Scholar
  5. 5.
    Herbella FA, Oliveira DRCF, Del Grande JC. Are idiopathic and chagasic achalasia two different diseases? Dig Dis Sci. 2004; 49(3): 353–60.Google Scholar
  6. 6.
    Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–33.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Galey KM, Wilshire CL, Niebisch S, Jones CE, Raymond DP, Litle VR, Watson TJ, Peters JH. Atypical variants of classic achalasia are common and currently under-recognized: a study of prevalence and clinical features. J Am Coll Surg. 2011; 213(1): 155–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Rezende JM, Lauar KM, Oliveira AR. Aspectos clínicos e radiológicos da aperistalse do esôfago. Rev Bras Gastroenterol. 1960; 12:247–62.PubMedGoogle Scholar
  9. 9.
    Ferreira-Santos R. Tratamento cirúrgico da aperistalse esofágica (megaesôfago). Dissertação. Ribeirão Preto. Univesidade de São Paulo, 1965.Google Scholar
  10. 10.
    Remes-Troche JM, Torres-Aguilera M, Antonio-Cruz KA, Vazquez-Jimenez G, De-La-Cruz-Patiño E. Esophageal motor disorders in subjects with incidentally discovered Chagas disease: a study using high-resolution manometry and the Chicago classification. Dis Esophagus. 2012 Oct 22. doi: 10.1111/j.1442-2050.2012.01438.x.Google Scholar
  11. 11.
    Todorczuk JR, Aliperti G, Staiano A, Clouse RE. Reevaluation of manometric criteria for vigorous achalasia. Is this a distinct clinical disorder? Dig Dis Sci. 1991; 36 (3): 274–78.PubMedCrossRefGoogle Scholar
  12. 12.
    Oliveira RB, Troncon LEA, Dantas RO, Meneghelli UG. Gastrointestinal manifestations of Chagas' disease. Am J Gastroenterol. 1998; 93 (6): 884–89.PubMedGoogle Scholar
  13. 13.
    Sanchez-Lermen RLP, Dick E, Salas JAP, Fontes CJ. Upper gastrointestinal symptoms and esophageal motility disorders in indeterminate Chagas disease patients. Rev. Soc. Bras. Med. Trop. 2007; 40 (2): 197–203.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Fernando P. P. Vicentine
    • 1
  • Fernando A. M. Herbella
    • 1
    • 3
  • Marco E. Allaix
    • 2
  • Luciana C. Silva
    • 1
  • Marco G. Patti
    • 2
  1. 1.Department of Surgery, Escola Paulista de MedicinaFederal University of São PauloSão PauloBrazil
  2. 2.Department of SurgeryUniversity of ChicagoChicagoUSA
  3. 3.Surgical Gastroenterology, Division of Esophagus and StomachHospital São PauloSão PauloBrazil

Personalised recommendations