Vigorous achalasia - Original description requires minor change

Vigorous achalasia was described in 1957 as a subset of achalasia with a hi gher contraction amplitude (> 37 mm Hg), minimal esophageal dilatation. pro minent tertiary contractions, and higher incidence of chest pain. Goals: As certain the existence of a distinct achalasia group based on manometric, ra diographic, and clinical grounds. Study: The records of 209 idiopathic acha lasia patients seen over a 9-year interval were reviewed for duration and f requency of dysphagia, chest pain, heartburn, weight loss, and nocturnal sy mptoms, as well as for treatment outcome. Manometric tracings were reanalyz ed for lower esophageal sphincter pressure (LESP), LES residual pressure, d istal esophageal contraction amplitude, and presence of repetitive waves. P atients were subsequently divided into classic (amplitude less than or equa l to 37 mm Hg) and vigorous (amplitude > 37 mm Hg) achalasia groups. Esopha grams were reassessed blindly for esophageal diameter both in the upright a nd recumbent positions and presence of lumen-occlusive tertiary contraction s. Results: One hundred forty-four classic and 65 vigorous achalasia patien ts were identified. These groups were similar in age and gender, as well as duration of symptoms. Chest pain was equally prevalent in both groups. Low er esophageal sphincter pressure was higher (p < 0.01) and repetitive waves more common (p < 0.0001) in the vigorous achalasia group. Upright esophage al diameter was smaller (p = 0.0003) and tertiary contractions more frequen t (p = 0.0004) in this group. Conclusion: The original manometric and radio graphic description of vigorous achalasia is accurate. The incidence of che st pain is similar to that of patients with classic achalasia.