Comparison of idiopathic achalasia and Chagas' disease esophagopathy at the light of high-resolution manometry

The comparison between idiopathic achalasia (IA) and Chagas' disease esophagopathy (CDE) may evaluate if treatment options and their outcomes can be accepted universally. This study aims to compare IA and CDE at the light of high-resolution manometry. We studied 86 patients with achalasia: 45 patients with CDE (54% females, mean age 55 years) and 41 patients with IA (58% females, mean age 49 years). All patients underwent high-resolution manometry. Upper esophageal sphincter parameters were similar (basal pressure CDE = 72 +/- 45mmHg, IA = 82 +/- 57mmHg; residual pressure CDE = 9.9 +/- 9.9mmHg, IA = 9.8 +/- 7.5mmHg). In the body of the esophagus, the amplitude was higher in the IA group than the CDE group at 3cm (CDE = 15 +/- 14mm Hg, IA = 42 +/- 52mmHg, P = 0.003) and 7cm (CDE = 16 +/- 15mmHg, IA = 36 +/- 57mmHg, P = 0.04) above the lower esophageal sphincter (LES). The LES basal pressure (CDE = 17 +/- 16mmHg, IA = 40 +/- 22mmHg, P < 0.001) and residual pressure (CDE = 12 +/- 11mmHg, IA = 27 +/- 13mmHg, P < 0.001) were also higher in the IA group. Our results show that: (i) there is no difference in regards to the upper esophageal sphincter; (ii) higher pressures of the esophageal body are noticed in patients with IA; and (iii) basal and residual pressures of the LES are lower in patients with CDE. Our results did not show expressive manometric differences between IA and CDE. Some differences may be attributed to a more pronounced esophageal dilatation in patients with CDE.