Achalasia is typically diagnosed with high IRP values in HRM systems. In Japan, data on the characteristics of patients with type I, II, and III achalasia are scarce, 10 and relevant data should be evaluated using the Starlet HRM system to establish a diagnosis and treatment strategy. 8 However, limited information is available about the difference in IRP values between Starlet and others in patients with achalasia. 8, 9 Integrated relaxation pressure (IRP) is the most important parameter in HRM findings for evaluating LES relaxation, and IRP values of Starlet were reported to have different cutoff points from ManoScan.
In the Starlet HRM system, mainly used in Japan, the cutoff points of several parameters have been reported in healthy volunteers. 4 ManoScan and Sandhill HRM systems are used worldwide, 5 and patients’ characteristics between type I, II, and III achalasia have been clarified in Western countries using these systems. 4 Using the ManoScan HRM system, the Chicago classification categorizes achalasia into 3 subgroups based on the type of esophageal contraction: type I, 100% failed peristalsis type II, pan-pressurization and type III, spastic contraction ( Supplementary Fig. 1 Recently, high-resolution manometry (HRM) was developed, 2, 3 and achalasia was clearly defined as an EMD with impaired lower esophageal sphincter (LES) relaxation and no normal esophageal peristalsis. Achalasia is a well-known esophageal motility disorder (EMD) characterized by the degeneration of the Auerbach plexus.
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