{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T12:44:44Z","timestamp":1789908284053,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2025,3]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>High\u2010resolution manometry (HRM) is a gold standard for diagnosing achalasia and identification of its subtypes, but data regarding its correlation with clinical, endoscopic, and radiological features in low\u2010resource settings like Pakistan are limited. This study aims to identify and compare manometric parameters with other diagnostic parameters among achalasia subtypes in Pakistani population.<\/jats:p><\/jats:sec>Methodology<\/jats:title>A retrospective analysis of clinical, endoscopic, and radiological features of 381 patients who underwent HRM at Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, Pakistan, from December 2015 to February 2024 was performed. Based on the HRM criterion, 213 patients were identified and categorized into subtypes: 132 cases for type I and 64 and 17 for type II and III, respectively.<\/jats:p><\/jats:sec>Results<\/jats:title>Patient demographics were similar across subtypes except for sex (male\u2010dominant in types I and II, female\u2010dominant in type III). Symptom duration was longest in type III (8\u2009years vs. 4.1\u2009years). Almost all patients had dysphagia; 83% reported regurgitation\/weight loss, 71% chest pain, and 64% vomiting. The endoscopy results were normal in 40% of patients, and barium swallow was inconclusive in just 13% of achalasia patients. Type III exhibited the highest EGJ relaxation pressure and lowest LES pressure. Notably, all subtypes displayed elevated IRP, with type I showing highest value.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>This study identified type I achalasia as the most prevalent subtype. While barium swallow and endoscopy showed limited diagnostic accuracy, HRM confirmed subtypes in all patients. Despite challenges with GERD\u2010like symptoms and inconclusive findings, further research is warranted to investigate specific clinical features of each subtype, potentially attributing to personalized treatment strategies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.70041","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T06:54:46Z","timestamp":1742367286000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Optimizing achalasia diagnosis in the era of high\u2010resolution manometry: A Pakistani perspective"],"prefix":"10.1002","volume":"9","author":[{"given":"Sameen","family":"Abbas","sequence":"first","affiliation":[{"name":"Department of Pharmacy Quaid\u2010i\u2010Azam University Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7914-4626","authenticated-orcid":false,"given":"Tayyab S","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Center for Liver and Digestive Diseases Holy Family Hospital Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sampath","family":"Chinnam","sequence":"additional","affiliation":[{"name":"Department of Chemistry M.S. Ramaiah Institute of Technology (Affiliated to Visvesvaraya Technological University, Belgaum) Bengaluru India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saima","family":"Mushtaq","sequence":"additional","affiliation":[{"name":"Department of Pharmacy The First Affiliated Hospital of Xi'an Jiaotong University Xi'an China"},{"name":"Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Health Science Center, Xi'an Jiaotong University Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafees","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences University of Balochistan Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy The First Affiliated Hospital of Xi'an Jiaotong University Xi'an China"},{"name":"Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Health Science Center, Xi'an Jiaotong University Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6006-4159","authenticated-orcid":false,"given":"Amjad","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Quaid\u2010i\u2010Azam University Islamabad Pakistan"},{"name":"Department of Pharmacy The First Affiliated Hospital of Xi'an Jiaotong University Xi'an China"},{"name":"Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Health Science Center, Xi'an Jiaotong University Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"issue":"1","key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41572-022-00356-8","article-title":"Achalasia","volume":"8","author":"Savarino E","year":"2022","journal-title":"Nature Reviews Disease Primers"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0140-6736(13)60651-0","article-title":"Achalasia","volume":"383","author":"Boeckxstaens GE","year":"2014","journal-title":"Lancet"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","DOI":"10.1111\/nmo.14605","article-title":"How to effectively use and interpret the barium swallow: current role in esophageal dysphagia","volume":"35","author":"Sanagapalli S","year":"2023","journal-title":"Neurogastroenterol. 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Gastroenterol."},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.22416\/1382-4376-2016-4-36-54","article-title":"Diagnostics and treatment of cardiac achalasia and cardiospasm: guidelines of the Russian gastroenterological association","volume":"26","author":"Ivashkin VT","year":"2016","journal-title":"Russ J Gastroenterol Hepatol Coloproctology."},{"key":"e_1_2_7_14_1","first-page":"301","article-title":"Treatment of achalasia in the era of high\u2010resolution manometry","volume":"28","author":"Torresan F","year":"2015","journal-title":"Ann. Gastroenterol."},{"key":"e_1_2_7_15_1","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.giec.2014.07.001","article-title":"The Chicago classification of motility disorders: an update","volume":"24","author":"Roman S","year":"2014","journal-title":"Gastrointest Endosc. 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