Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspective
Abstract Background High‐resolution manometry (HRM) is a gold standard for diagnosing achalasia and identification of its subtypes, but data regarding its correlation with clinical, endoscopic, and radiological features in low‐resource settings like Pakistan are limited. This study aims to identify...
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Wiley
2025-03-01
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| Online Access: | https://doi.org/10.1002/jgh3.70041 |
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| author | Sameen Abbas Tayyab S Akhtar Sampath Chinnam Saima Mushtaq Nafees Ahmad Yu Fang Amjad Khan |
| author_facet | Sameen Abbas Tayyab S Akhtar Sampath Chinnam Saima Mushtaq Nafees Ahmad Yu Fang Amjad Khan |
| author_sort | Sameen Abbas |
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| description | Abstract Background High‐resolution manometry (HRM) is a gold standard for diagnosing achalasia and identification of its subtypes, but data regarding its correlation with clinical, endoscopic, and radiological features in low‐resource settings like Pakistan are limited. This study aims to identify and compare manometric parameters with other diagnostic parameters among achalasia subtypes in Pakistani population. Methodology A retrospective analysis of clinical, endoscopic, and radiological features of 381 patients who underwent HRM at Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, Pakistan, from December 2015 to February 2024 was performed. Based on the HRM criterion, 213 patients were identified and categorized into subtypes: 132 cases for type I and 64 and 17 for type II and III, respectively. Results Patient demographics were similar across subtypes except for sex (male‐dominant in types I and II, female‐dominant in type III). Symptom duration was longest in type III (8 years vs. 4.1 years). Almost all patients had dysphagia; 83% reported regurgitation/weight loss, 71% chest pain, and 64% vomiting. The endoscopy results were normal in 40% of patients, and barium swallow was inconclusive in just 13% of achalasia patients. Type III exhibited the highest EGJ relaxation pressure and lowest LES pressure. Notably, all subtypes displayed elevated IRP, with type I showing highest value. Conclusion This study identified type I achalasia as the most prevalent subtype. While barium swallow and endoscopy showed limited diagnostic accuracy, HRM confirmed subtypes in all patients. Despite challenges with GERD‐like symptoms and inconclusive findings, further research is warranted to investigate specific clinical features of each subtype, potentially attributing to personalized treatment strategies. |
| format | Article |
| id | doaj-art-bc7d014742014df58c9b6494cc0edcf5 |
| institution | DOAJ |
| issn | 2397-9070 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | JGH Open |
| spelling | doaj-art-bc7d014742014df58c9b6494cc0edcf52025-08-20T02:41:55ZengWileyJGH Open2397-90702025-03-0193n/an/a10.1002/jgh3.70041Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspectiveSameen Abbas0Tayyab S Akhtar1Sampath Chinnam2Saima Mushtaq3Nafees Ahmad4Yu Fang5Amjad Khan6Department of Pharmacy Quaid‐i‐Azam University Islamabad PakistanCenter for Liver and Digestive Diseases Holy Family Hospital Rawalpindi PakistanDepartment of Chemistry M.S. Ramaiah Institute of Technology (Affiliated to Visvesvaraya Technological University, Belgaum) Bengaluru IndiaDepartment of Pharmacy The First Affiliated Hospital of Xi'an Jiaotong University Xi'an ChinaDepartment of Pharmacy Practice, Faculty of Pharmacy and Health Sciences University of Balochistan Quetta PakistanDepartment of Pharmacy The First Affiliated Hospital of Xi'an Jiaotong University Xi'an ChinaDepartment of Pharmacy Quaid‐i‐Azam University Islamabad PakistanAbstract Background High‐resolution manometry (HRM) is a gold standard for diagnosing achalasia and identification of its subtypes, but data regarding its correlation with clinical, endoscopic, and radiological features in low‐resource settings like Pakistan are limited. This study aims to identify and compare manometric parameters with other diagnostic parameters among achalasia subtypes in Pakistani population. Methodology A retrospective analysis of clinical, endoscopic, and radiological features of 381 patients who underwent HRM at Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, Pakistan, from December 2015 to February 2024 was performed. Based on the HRM criterion, 213 patients were identified and categorized into subtypes: 132 cases for type I and 64 and 17 for type II and III, respectively. Results Patient demographics were similar across subtypes except for sex (male‐dominant in types I and II, female‐dominant in type III). Symptom duration was longest in type III (8 years vs. 4.1 years). Almost all patients had dysphagia; 83% reported regurgitation/weight loss, 71% chest pain, and 64% vomiting. The endoscopy results were normal in 40% of patients, and barium swallow was inconclusive in just 13% of achalasia patients. Type III exhibited the highest EGJ relaxation pressure and lowest LES pressure. Notably, all subtypes displayed elevated IRP, with type I showing highest value. Conclusion This study identified type I achalasia as the most prevalent subtype. While barium swallow and endoscopy showed limited diagnostic accuracy, HRM confirmed subtypes in all patients. Despite challenges with GERD‐like symptoms and inconclusive findings, further research is warranted to investigate specific clinical features of each subtype, potentially attributing to personalized treatment strategies.https://doi.org/10.1002/jgh3.70041achalasiabarium swallowclassificationdiagnosisendoscopyHRM |
| spellingShingle | Sameen Abbas Tayyab S Akhtar Sampath Chinnam Saima Mushtaq Nafees Ahmad Yu Fang Amjad Khan Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspective JGH Open achalasia barium swallow classification diagnosis endoscopy HRM |
| title | Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspective |
| title_full | Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspective |
| title_fullStr | Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspective |
| title_full_unstemmed | Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspective |
| title_short | Optimizing achalasia diagnosis in the era of high‐resolution manometry: A Pakistani perspective |
| title_sort | optimizing achalasia diagnosis in the era of high resolution manometry a pakistani perspective |
| topic | achalasia barium swallow classification diagnosis endoscopy HRM |
| url | https://doi.org/10.1002/jgh3.70041 |
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