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Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Food Pipe & Gastro Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
The type is a label from a pressure test of the food pipe. It tells the doctor how the muscle of the pipe behaves above the tight valve.
Types I and II usually respond well to a Heller operation, POEM or balloon dilation. Type III is the spastic form, and it is usually treated with POEM.
The type cannot be guessed from symptoms. It comes only from high-resolution manometry, checked against an endoscopy and a barium swallow.
For the whole picture of achalasia, from tests to the choice between POEM and Heller operation, read our achalasia treatment page. This post explains only the three types.
In all three types the valve at the lower end of the food pipe fails to open. What differs is what the muscle of the pipe above the valve does while you swallow.
In a healthy food pipe, a wave of squeezing pushes food down, and the valve opens as the wave arrives. In achalasia the valve stays tight. The wave is also lost or disordered. Food and water collect above the valve, and the pipe may widen over the years.
The three types are read from a pressure tracing, made while you swallow small sips of water. The grouping is part of the Chicago Classification, the set of rules that doctors use to read these tracings.
The type comes from high-resolution manometry. A thin tube with many pressure sensors rests across the food pipe, and the tracing is read swallow by swallow.
You sit or lie down, the tube is passed through the nose, and you take about ten small sips of water. The test takes a short time and needs no anaesthesia. A numbing jelly is used in the nose.
The type is never decided from manometry alone. An endoscopy is done first in every patient. It looks for a narrowing or growth near the valve that can imitate achalasia. A timed barium swallow is added, because it shows how well the pipe empties and gives a baseline for later comparison.
Type II is the one that usually does very well with treatment. Type I is close behind. Type III is harder to treat, because the spasm reaches higher up the pipe than the valve.
| Point | Type I | Type II | Type III |
|---|---|---|---|
| Valve | Does not open | Does not open | Does not open |
| Pipe above the valve | No squeeze at all | Whole pipe pressurises together | Early, strong, out-of-step spasms |
| Chest pain | Less often | Sometimes | More often, and may be severe |
| Pipe on barium film | Often widened, may be stretched late | Often only mildly widened | May show a corkscrew look |
| Response to treatment | Good with Heller, POEM or dilation | Usually a very good response | Less predictable, POEM favoured |
These are patterns, not rules. Some people sit between two types, and a second tracing can read differently from the first. This is why the pressure test is read together with the endoscopy and the barium film, not alone.
Every treatment opens the tight valve. The type decides how far up the food pipe the cut or stretch must reach, and so which procedure suits you.
Dr Harsh Shah does laparoscopic and open surgery. For POEM or balloon dilation the plan is made with the endoscopy team after your reports are reviewed. No treatment restores the lost squeezing wave. All of them aim to let food pass the valve.
| Your type | Usually favoured | Main thing to weigh |
|---|---|---|
| Type I, fit for surgery | Heller with wrap, or POEM | Reflux after POEM, and how wide the pipe is |
| Type II, fit for surgery | Heller with wrap, POEM or dilation | Choice rests on your priorities |
| Type III | POEM with a long cut | Length of spasm on the tracing |
| Not fit for an operation | Dilation or botulinum injection | Relief may need repeating |
No. Trouble swallowing both solids and liquids, regurgitation and weight loss occur in all three types. Chest pain is commoner in type III, but it does not prove it.
Many people carry a label of acidity or reflux for years before the correct diagnosis. Tablets for acid do not help much. Food sticks, and some is brought back up undigested, sometimes at night on the pillow.
Pain in the chest can also come from the heart. A heart check is sensible if the pain is new or severe. It is not safe to assume the pain is “only spasm”.
Ask which type you were told. Ask whether the endoscopy ruled out a growth near the valve, and what the barium film showed. These three answers shape the treatment advice.
Call us soon if you cannot swallow even saliva. Call soon too if you are losing weight fast, or if food goes into your breath and causes cough or chest infection. These need a prompt review, not a wait for the next appointment.
Type I is the classic form, where the food pipe above the valve does not squeeze. Type II shows the whole pipe pressurising together. Type III is the spastic form, with early and out-of-step contractions. In all three the valve at the lower end does not open.
The type is read from high-resolution manometry, a pressure test done with a thin tube across the food pipe. It is checked against an endoscopy and a timed barium swallow, so that a growth near the valve is not missed.
Type II usually does very well with treatment, and type I does well too. Type III is harder to treat because the spasm lies higher in the pipe. Each person is judged individually.
No. Trouble swallowing, regurgitation and weight loss occur in every type. Chest pain is commoner in type III, but only the pressure test can name the type.
POEM is usually favoured, because it allows a long cut that follows the spastic part of the pipe. A Heller operation can be extended in some cases, and the choice depends on your tracing, your fitness and the team.
A repeat test can read differently, especially if the first tracing was borderline. A long-standing type I pipe may widen further. This is why a repeat tracing and a barium film are used when the picture is unclear.
See a doctor soon if you cannot swallow even saliva or are losing weight fast. Also go if food goes into the breath and causes cough or chest infection. These need a prompt review.
For the full picture of achalasia and its treatment, start at the achalasia treatment page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Told you have achalasia, and then asked about "type I, II or III"? Dr Harsh Shah is a food pipe and gastro surgeon in Ahmedabad. He explains what these types mean and why your manometry report names one. Bring the report and your barium film. You can also call us or write on WhatsApp. Call For Appointment Book on WhatsApp Tapping Book on WhatsApp will likely open the WhatsApp app on your phone.
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