Prior to the introduction of high-resolution manometry (HRM), achalasia was a singular diagnosis based on water-perfused pull-through manometry. With the introduction of high-resolution manometry and the Chicago classification system, we have become more astute to the variations in motility disorders that result in failure of the lower esophageal sphincter with disordered esophageal peristalsis. However, as a clinician, is the treatment for each subtype really different? Further, after you have established a diagnosis and ruled-out any causes of pseudo-achalasia, should you treat Type III achalasia any different than Type I or II achalasia?
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