Type III achalasia—a clinical description

Achalasia is a disease characterized by dysphagia, regurgitation, chest pain, and weight loss. It is now classified into three subtypes according to the Chicago classification. Type III achalasia is characterized by lower esophageal sphincter obstruction but also spastic activity in the esophageal body. This spastic activity could lead to a different symptom profile to other achalasia patients. We reviewed the notes of 36 patients with type III achalasia to determine their clinical presentation. We compared them with 137 patients with type II achalasia and 21 with distal esophageal spasm. Type III patients had a mean age of 63 years, and they had symptoms for a mean of 4.5 years prior to diagnosis. 97% presented with dysphagia, 79% with regurgitation, 61% with chest pain and 22% with weight loss. This pattern was similar to that of type II patients with the exception of age (mean of 63 years vs. 52 years) and length of symptoms prior to diagnosis (mean of 4.5 years vs. 2.5 years). Type III patients had a similar age (mean of 63 years and 64 years) to distal esophageal spasm patients. Type III patients have a similar symptom profile to type II patients, and more symptoms than distal esophageal spasm patients, suggesting that most symptoms in achalasia are due to lower esophageal sphincter obstruction rather than esophageal spasm. Type III achalasia patients arise in a distinctly older population than type II achalasia, suggesting these two groups might be distinct regarding their underlying pathophysiological process.