On esophageal manometry, abnormal spastic contractions in esophagus > 450 mmHgs cm in the body is suggestive of:
ACHALASIA CARDIA Characterized by absence of LES relaxation Clinical features - MC symptom - Dysphagia > weight loss | (Liquid > Solid) - Triad Dysphagia Regurgitation Weight loss IOC - Manometry On Barium Swallow * Bird beak appearance * Pencil tip appearance * Rat tail appearance TypeI: classic achalasia,incomplete LES relaxation, aperistalsis and absence of esophageal pressurization.Elevated median IRP(integrated relaxation pressure) >15 mmHg, 100% failed peristalsis DCT <100mmHg cm,premature contractions with DCT <450mmHg cm TypeII: incomplete LES relaxation, aperistalsis ,Elevated median IRP(integrated relaxation pressure) >15 mmHg, 100% failed peristalsis,panesophageal pressurization in at least 20% of swallows., contractions may be masked by oesophageal pressurisation and DCT should not be calculated Type III achalasia(spastic achalasia) Elevated median IRP (>15 mmHg), No normal peristalsis, Premature (spastic) contractions with DCI >450 mmHg*s*cm with >=20% of swallows May be mixed with panoesophageal pressurisation Jackhammer esophagus : is characterized by DCI > 8000 mmHg*sec*cm in at least 20% of swallows and normal DL
Type I achalasia
Type II achalasia
Type III achalasia
Jackhammer esophagus
NEET Jan 2020