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E1680. The New Chicago Classification of Achalasia: What is it and How Does it Correlate With the Barium Swallow?
Authors
  1. Teal Clocksin; University of New Mexico
  2. Samuel Martinez; University of New Mexico
  3. Tabitha Kirkendall; University of New Mexico
  4. Archana Kaza; University of New Mexico
  5. William Thompson; University of New Mexico
Background
The new Chicago Achalasia Classification expanded conventional Achalasia in to 3 distinct subtypes: Type I: Conventional achalasia with absent peristalsis, esophageal dilatation and incomplete relaxation of the LES (Bird Beak). Type II: Absent peristalsis, impaired LES relaxation and increased pan-esophageal pressures. Type III: Absent peristalsis, impaired LES and distal simultaneous spastic contractions (Corkscrew Esophagus/Diffuse esophageal spasm). Treatment failure rates vary from the best in Type I to the worst in Type III. Based upon our experience the Barium Swallow correlates well with manometry for Type I but not with Types II and III.

Educational Goals / Teaching Points
After reviewing this poster the reviewer will 1. Know the Chicago Classification of Achalasia 2. Know the clinical findings in the 3 types of Achalasia 3. Understand the manometric findings in Achalasia 4. Know the classic findings on Esophagograms of the 3 three types of Achalasia 5. Understand the different types of treatment for each type of Achalasia and their outcome 6. Know about other forms of Esophageal dysmotility

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Esophageal dysmotility, Esophageal manometry, Chicago Classification of Achalasia, Correct performance of the Barium Swallow

Conclusion
1. The New Chicago Classification of Achalasia divides Achalasia into 3 separate types: Type I: Conventional achalasia with absent peristalsis, esophageal dilatation and incomplete relaxation of the LES (Bird Beak). Type II: Absent peristalsis, impaired LES relaxation and increased pan-esophageal pressures. Type III: Absent peristalsis, impaired LES and distal simultaneous spastic contractions (Corkscrew Esophagus/ Diffuse esophageal spasm). 2. The treatment varies depending upon the Type with I better than Type II and Type III the worst. 3. To date there have been few attempts to correlate the findings on the esophagogram with manometry. Our small study demonstrated perfect correlation with Type I but very poor correlation with Types II and III. 4. A larger study needs to be performed to confirm our results.