{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:26:03Z","timestamp":1784031963274,"version":"3.55.0"},"reference-count":32,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; p &lt; 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; p = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 (p = 0.011), subtype 2 and subtype 3 (p = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters (p &lt; 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes (p &lt; 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and\/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.<\/jats:p>","DOI":"10.3390\/diagnostics13132198","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:49:47Z","timestamp":1687999787000},"page":"2198","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Achalasia Subtype Differences Based on Respiratory Symptoms and Radiographic Findings"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8529-8624","authenticated-orcid":false,"given":"Jelena","family":"Jankovic","sequence":"first","affiliation":[{"name":"Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0767-6869","authenticated-orcid":false,"given":"Branislava","family":"Milenkovic","sequence":"additional","affiliation":[{"name":"Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3600-6247","authenticated-orcid":false,"given":"Ognjan","family":"Skrobic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Digestive Surgery, First Surgical University Hospital, Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1413-5072","authenticated-orcid":false,"given":"Nenad","family":"Ivanovic","sequence":"additional","affiliation":[{"name":"Clinic for Digestive Surgery, First Surgical University Hospital, Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0825-4748","authenticated-orcid":false,"given":"Natasa","family":"Djurdjevic","sequence":"additional","affiliation":[{"name":"Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Buha","sequence":"additional","affiliation":[{"name":"Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Jandric","sequence":"additional","affiliation":[{"name":"Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6516-1970","authenticated-orcid":false,"given":"Nikola","family":"Colic","sequence":"additional","affiliation":[{"name":"Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4655-2383","authenticated-orcid":false,"given":"Jelena","family":"Milin-Lazovic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","article-title":"ACG Clinical Guidelines: Diagnosis and Management of Achalasia","volume":"115","author":"Vaezi","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1540\/jsmr.59.14","article-title":"Clinical characteristics and manometric findings of esophageal achalasia\u2014A systematic review regarding differences among three subtypes","volume":"59","author":"Katsumata","year":"2023","journal-title":"J. Smooth Muscle Res."},{"key":"ref_3","first-page":"100","article-title":"Characteristics of Achalasia Subtypes: Result of a Study in a Tertiary Hospital","volume":"13","author":"Alvand","year":"2022","journal-title":"Casp. J. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5066","DOI":"10.1007\/s00464-017-5570-5","article-title":"The relationship between manometric subtype and outcomes of surgical treatment for patients with achalasia: Achalasia: Manometric subtypes","volume":"31","author":"Crespin","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/nyas.14510","article-title":"Achalasia: Physiology and diagnosis","volume":"1482","author":"Rieder","year":"2020","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_6","first-page":"e12351","article-title":"Lung Nodule and Food Bolus Impaction: Can They Be Related?","volume":"12","author":"Carvalho","year":"2020","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1089\/lap.2016.0246","article-title":"Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy","volume":"26","author":"Andolfi","year":"2016","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1007\/s00268-022-06483-3","article-title":"Esophageal Achalasia: Diagnostic Evaluation","volume":"46","author":"Riccio","year":"2022","journal-title":"World J. Surg."},{"key":"ref_9","first-page":"e1376","article-title":"Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification","volume":"31","author":"Herbella","year":"2018","journal-title":"ABCD Arq. Bras. De Cir. Dig. (S\u00e3o Paulo)"},{"key":"ref_10","first-page":"411","article-title":"An overview of achalasia and its subtypes","volume":"13","author":"Patel","year":"2017","journal-title":"Gastroenterol. Hepatol. (N. Y.)"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/j.1442-2050.2010.01126.x","article-title":"Prevalence of respiratory symptoms in patients with achalasia","volume":"24","author":"Sinan","year":"2010","journal-title":"Dis. Esophagus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e90","DOI":"10.1093\/ejcts\/ezs421","article-title":"Clinical, radiological and functional assessment of pulmonary status in patients with achalasia cardia before and after treatment","volume":"42","author":"Parshad","year":"2012","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1378\/chest.123.2.608","article-title":"Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia","volume":"123","author":"Akritidis","year":"2003","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1136\/gut.44.2.231","article-title":"Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: A randomized trial","volume":"44","author":"Vaezi","year":"1999","journal-title":"Gut"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1080\/17474124.2018.1441023","article-title":"Clinical management of pediatric achalasia","volume":"12","author":"Omari","year":"2018","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e14058","DOI":"10.1111\/nmo.14058","article-title":"Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0\u00a9","volume":"33","author":"Yadlapati","year":"2021","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"485","DOI":"10.5056\/jnm.2013.19.4.485","article-title":"Clinical Characteristics and Treatment Outcomes of 3 Subtypes of Achalasia According to the Chicago Classification in a Tertiary Institute in Korea","volume":"19","author":"Lee","year":"2013","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4103\/1319-3767.157560","article-title":"Clinical, Endoscopic, and Radiologic Features of Three Subtypes of Achalasia, Classified Using High-Resolution Manometry","volume":"21","author":"Khan","year":"2015","journal-title":"Saudi J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1365-2982.2011.01833.x","article-title":"Achalasia and esophago-gastric junction outflow obstruction: Focus on the subtypes","volume":"24","author":"Boeckxstaens","year":"2012","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_20","first-page":"G212","article-title":"Functional morphology of the lower esophageal sphincter and crural diaphragm determined by three-dimensional high-resolution esophago-gastric junction pressure profile and CT imaging","volume":"313","author":"Mittal","year":"2017","journal-title":"Am. J. Physiol. Liver Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e13287","DOI":"10.1111\/nmo.13287","article-title":"Evaluating the reliability and construct validity of the Eckardt symptom score as a measure of achalasia severity","volume":"30","author":"Taft","year":"2018","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/0003-4975(89)90369-X","article-title":"Esophageal resection for achalasia: Indications and results","volume":"47","author":"Orringer","year":"1989","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1007\/s00595-022-02503-w","article-title":"Correlation between our symptom-based scoring system and the Eckardt score for assessing patients with esophageal achalasia","volume":"52","author":"Tsuboi","year":"2022","journal-title":"Surg. Today"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.12998\/wjcc.v11.i8.1741","article-title":"Pathogenesis, clinical manifestations, diagnosis, and treatment progress of achalasia of cardia","volume":"11","author":"Li","year":"2023","journal-title":"World J. Clin. Cases"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.rgmx.2017.03.008","article-title":"Difference of achalasia subtypes based on clinical symptoms, radiographic findings, and stasis scores","volume":"83","author":"Meillier","year":"2018","journal-title":"Rev. Gastroenterol. M\u00e9xico (Engl. Ed.)"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"603-e20","DOI":"10.1111\/j.1365-2982.2009.01268.x","article-title":"Structural and functional abnormalities in lungs in patients with achalasia","volume":"21","author":"Makharia","year":"2009","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1159\/000501057","article-title":"Value of Multidetector Computed Tomography in the Assessment of Achalasia Subtypes and Detection of Pulmonary and Thoracic Complications","volume":"28","author":"Jovanovic","year":"2019","journal-title":"Med. Princ. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"105","DOI":"10.4166\/kjg.2019.73.2.105","article-title":"Achalasia Cardia Resulting in Bronchial Obstruction: A Case Series and Literature Review","volume":"73","author":"Then","year":"2019","journal-title":"Korean J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1089\/lap.2019.0242","article-title":"A Decade of Investigation: Peroral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy for Achalasia","volume":"29","author":"Olson","year":"2019","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11605-018-3956-x","article-title":"A Thousand and One Laparoscopic Heller Myotomies for Esophageal Achalasia: A 25-Year Experience at a Single Tertiary Center","volume":"23","author":"Costantini","year":"2019","journal-title":"J. Gastrointest. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1136\/gutjnl-2015-310602","article-title":"Long-term results of the European achalasia trial: A multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy","volume":"65","author":"Moonen","year":"2015","journal-title":"Gut"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.athoracsur.2018.09.059","article-title":"Reintervention After Heller Myotomy for Achalasia: Is It Inevitable?","volume":"107","author":"Raja","year":"2019","journal-title":"Ann. Thorac. Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/13\/2198\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:02:39Z","timestamp":1760126559000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/13\/2198"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,28]]},"references-count":32,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["diagnostics13132198"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13132198","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,28]]}}}