Table 1.
Proposed Patterns of Neuronal Function (Postganglionic and Vagal) Among Achalasia Subgroups
| LES |
Distal (smooth muscle) esophagus |
||||
|---|---|---|---|---|---|
| Achalasia subgroup |
Inhibitory | Excitatory | Circular muscle inhibitory |
Circular muscle excitatory |
Longitudinal muscle excitatory |
| Type I (classic) | − − | − − | − − | − − | − − to − |
| Type II (with compression) |
− | − to++ | − | − | + to ++ |
| Type III (spastic) | − | + to++ | − | + to++ | + to++ |
| EGJ outflow obstructiona |
− | − to++ | − to + | − to++ | + to++ |
NOTE. ++, accentuation; +, preservation; −, reduction; − −, elimination. The inferences regarding preserved neural function are based on TLESRs with achalasia, the distal latency of peristalsis premyotomy and postmyotomy, recovery of peristalsis after treatment, and postdeglutitive LES contractions. The table is conceptual, indicative of the “classic case” of each subtype. Clinically, it is sometimes hard to distinguish type I from type II, type II from EGJ outflow obstruction, and type III from type II in borderline cases.
a
Some, but not all, cases of EGJ outflow obstruction are achalasia.