2% with type III. In comparison, older patients had a more even distribution of achalasia sub-types (type I: 36.1%; type II:
33.3% and type III: 30.6%; Figure). Furthermore, older subjects had a decrease in the incidence of type II (p < 0.05), and a trend towards a higher prevalence of type III (p = 0.1) when compared to younger patients. Conclusion: The lower incidence of type II, and the trend towards an increased incidence in type III achalasia in older patients was unexpected given the concept of a progression towards aperistalsis over time. The reasons for this are unclear, but if confirmed, may have implications for treatment approaches in older patients. 1. Pandolfino JE, et al. Gastroenterology 2008; 135(5): 1526–1533 2. Bredenoord AJ, et al. Neurogastroenterol Motil 2012; 24: 57–65. 3. Nicodeme F, et al. PD98059 mouse Clinical Gastroenterol Hepatol 2013; 11(2):131–137 CM BURGSTAD,1 LK BESANKO,1 R HEDDLE,1 E CLIFTON,1 S LAU,1 D KPT330 HOFFMAN,1 J MARTIN,1 RJL FRASER,2 C COCK1 1Investigation & Procedures Unit, 2Repatriation General Hospital, Daw Park and Department of Gastroenterology & Hepatology, Flinders University, Bedford Park; South Australia Background: The differentiation of achalasia according
to subtype (type I, II and III) has clinical relevance for type of treatment and subsequent outcome. The Chicago classification involves detailed analysis of oesophageal body and lower oesophageal sphincter using high resolution manometry. Data on the reproducibility of this analysis and diagnostic findings between expert and non-experienced reporters are limited1. Aim: To assess the “reliability” HAS1 of achalasia sub-typing using the Chicago classification, and evaluate the diagnostic consistency between reporters with varying experience.
Methods: Motility studies from 117 patients with a manometric diagnosis of “achalasia” were reviewed by eight raters, divided into 2 groups: ‘experienced’ (n = 4) and ‘inexperienced’ (n = 4). Studies were re-classified according to sub-type (I, II or III) based on Chicago criteria2. Post hoc analysis of all data for experienced raters was used to determine “gold standard” ratings. Cases where agreement could not be reached were excluded from analysis. Absolute agreement between raters was determined using intraclass correlation co-efficient (SPSS v16.0) and a P value < 0.05 was considered significant. Results: Intra-class correlation coefficient (ICC) was high for both experienced [0.905 (0.870–0.932)] and inexperienced [0.875 (0.831–0.910)] raters with an overall ICC for all raters of 0.879 (0.781–0.928; p < 0.001). When comparing the intra-rater reliability, the experienced raters had good to very good agreement for type I (91%) and type II (88%) sub-types, but were more variable with type III achalasia (75%). In contrast, the inexperienced raters were in highest agreement for sub-types II (72%) and III (92%), but consistency was lower with type 1 (58%); Figure.