The Pathophysiology of Esophageal Achalasia, As Described by The Chicago Classification, Corresponds in Most Cases to GERD

Dorot. Medical Center for Rehabilitation and Geriatrics, Netanya, Israel

*Corresponding Author: Michael D Levin, MD, Ph.D, Dorot. Medical Center for Rehabilitation and Geriatrics, Department of Pediatric Radiology of the 1-st State Hospital, Minsk, Belarus, Dorot. Medical Center for Rehabilitation and Geriatrics, Amnon veTamar, Netanya, Israel, Tel: 972-538281393, Email: [email protected]

Received Date: November 10, 2025

Published Date: November 25, 2025

Citation: Levin MD. (2025). The Pathophysiology of Esophageal Achalasia, As Described by The Chicago Classification, Corresponds in Most Cases to GERD. Mathews J Gastroenterol Hepatol. 10(3):36.

Copyrights: Levin MD. © (2025).

ABSTRACT

Background: Adoption of high-resolution manometry (HRM) and the Chicago Classification has led to a dramatic increase in the diagnosis of esophageal achalasia. To determine the cause of this phenomenon, we decided to examine pathophysiologic distinctions between gastroesophageal reflux disease (GERD) and esophageal achalasia (EA), diagnosed using HRM. Methods: We reviewed radiographic, manometric, endoscopic, and histologic markers of gastroesophageal junction (EGJ) disease. We contrasted HRM-based diagnoses with radiographic studies with maximum provocation, с histologic criteria and reviewed outcomes following myotomy/POEM. Results: HRM was introduced as a method for studying esophageal pressure by engineers and physicians ignorant of normal and pathological physiology. The selection of the control group was carried out in violation of scientific methodology, and diagnostic parameters were selected by a vote of individuals interested in the widespread use of recording equipment. Radiographic studies with maximal provocation allow one to measure with mathematical precision the width of the esophagus, the length of the lower esophageal sphincter (LES) and pathological esophageal sphincters. Histological studies may identify shortening of the intra-abdominal lower esophageal sphincter, peptic stenosis, or mucosal change (squamo-oxyntic gap) consistent with GERD. Comparison of EA diagnostic results by different methods revealed that HRM most often diagnoses EA, whereas based on radiographic examinations with maximum provocation typical cases of GERD were diagnosed. Significant rates of reflux/esophagitis after LES myotomy procedures, particularly POEM, were found. Transection of the LES permanently eliminates residual anti-reflux competence and predisposes patients to clinically significant GERD. Conclusions: HRM is not a scientifically validated method. It diagnoses EA in patients with GERD, which is an indication for treatment, as if the patient had true GERD. Dissection of a weak but functioning LES permanently destroys the antireflux function of the LES, which worsens the prognosis. Radiographic diagnostics using maximum provocation allows for the mathematically accurate diagnosis of GERD and true EA. Scientific discussion is needed to determine the best diagnostic and treatment options for patients with GERD.

Keywords: Gastroesophageal Reflux Disease, Esophageal Achalasia, X-Ray Diagnosis, High-Resolution Manometry, Pathophysiology of Esophageal Gastric Junction, Peroral Endoscopic Myotomy, Blown-Out Myotomy.