Question

Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

• A. Type 1 achalasia
• B. Type 2 achalasia
• C. Type 3 achalasia
• D. Jackhammer esophagus

Answer 1

The Correct Option is C

Anchor on the number: The single discriminating value is a distal contractile integral above 450 mmHg.s.cm. In the Chicago classification a high DCI means strong, premature, spastic contractions, which is the signature of the spastic subtype.

Confirm it is achalasia: All achalasia types share an impaired lower esophageal sphincter, shown by a raised median IRP with no normal peristalsis, so the obstruction is at the gastroesophageal junction.

Sort the subtypes by contraction: Type 1 has flat, failed contractions with a low DCI. Type 2 shows panesophageal pressurization but no measurable strong contraction, so DCI is not even reported. Type 3 is the one that pairs the relaxation defect with vigorous spastic contractions, DCI above 450, which exactly matches the stem.

Why not jackhammer: Jackhammer esophagus is also hypercontractile, but its IRP and sphincter relaxation are normal. Because this patient has the relaxation defect, the answer stays inside achalasia, specifically Type 3.

Ref: Bailey and Love, Short Practice of Surgery, 27e, Pg 1096, 1099.