Subtype of Achalasia and Integrated Relaxation Pressure Measured Using the Starlet High-resolution Manometry System: A Multicenter Study in Japan

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  • Tetsuya Tatsuta
    Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
  • Hiroki Sato
    Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
  • Yusuke Fujiyoshi
    Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
  • Hirofumi Abe
    Department of Gastroenterology, Kobe University Hospital, Kobe, Japan
  • Akio Shiwaku
    Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
  • Junya Shiota
    Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
  • Chiaki Sato
    Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Sendai, Japan
  • Masaki Ominami
    Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Yoshitaka Hata
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Hisashi Fukuda
    Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
  • Ryo Ogawa
    Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
  • Jun Nakamura
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
  • Yuichiro Ikebuchi
    Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine, Yonago, Japan
  • Hiroshi Yokomichi
    Department of Health Sciences, University of Yamanashi, Yamanashi, Japan
  • Shinsaku Fukuda
    Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
  • Haruhiro Inoue
    Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan

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ManoScan and Sandhill high-resolution manometry (HRM) systems are used worldwide; however, the diagnosis of achalasia on the Starlet HRM system is not fully characterized. Furthermore, the impact of calcium channel blockers and nitrites in treating achalasia has not been investigated using HRM. Management of recurrent cases is a priority issue, although few studies have examined patient characteristics.We conducted a multicenter, large-scale database analysis. First, the diagnosis of treatment-naive achalasia in each HRM system was investigated. Next, patient characteristics were compared between type I-III achalasia, and the impact of patient characteristics, including calcium channel blocker and nitrite use for integrated relaxation pressure (IRP) values, were analyzed. Finally, patient characteristics with recurrent achalasia were elucidated.The frequency of type I achalasia with Starlet was significantly higher than that with ManoScan and Sandhill HRM systems. In achalasia, multivariate analysis identified male sex, advanced age, long disease duration, obesity, type I achalasia, and sigmoid type as risk factors related to normal IRP values (26 mmHg). Calcium channel blockers and nitrites use had no significant impact on the IRP values, although achalasia symptoms were indicated to be alleviated. In recurrent cases, the IRP value was significantly lower, and advanced age, long disease duration, and sigmoid type were more common than in treatment-naive patients.We should cautiously interpret the type of achalasia and IRP values in the Starlet HRM system. Symptoms of recurrent cases are related to disease progression rather than IRP values, which should be considered in decision making.

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