A 29-year-old woman presents with progressive dysphagia to both liquids and solids, nocturnal regurgitation of undigested food, and weight loss. Chest radiograph shows absence of the gastric air bubble. High-resolution oesophageal manometry is performed to confirm the suspected diagnosis. Which pattern confirms the diagnosis?
- A Elevated integrated relaxation pressure with absent peristalsis ✓
- B Premature distal contractile waves with normal LES relaxation
- C Hypercontractile distal esophageal pressurization exceeding 8000 mmHg.s.cm
- D Weak peristaltic contractions with intact LES relaxation and normal IRP
Correct answer: A. Elevated integrated relaxation pressure with absent peristalsis
Explanation
Achalasia is defined manometrically by impaired LES relaxation, expressed as an elevated integrated relaxation pressure, together with absent peristalsis in the esophageal body. Premature distal contractions with normal LES relaxation define distal esophageal spasm, the jackhammer pattern defines hypercontractile esophagus, and weak peristalsis with normal IRP defines ineffective esophageal motility, all of which can cause dysphagia but do not meet criteria for achalasia.
Reference: Sabiston Textbook of Surgery, 21st ed.
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