A304 A CASE REPORT ILLUSTRATING THE NATURAL PROGRESSION OF TYPE 3 TO TYPE 2 ACHALASIA
Bibliographic record
Abstract
Achalasia is characterized by the loss of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter. The pathophysiology of this disease is thought to be related to the progressive loss of nitrergic inhibitory innervation in the esophagus. This hypothesis is supported by histological studies in patients diagnosed with achalasia, in whom there is a decrease of neurons containing nitric oxide synthase and interstitial cells of Cajal, a unit that likely modulates nitrergic nerve response. With the advent of high resolution esophageal manometry study (EMS) and subsequent increase in diagnostic precision, achalasia is now readily subdivided into types 1, 2 and 3. Given that the normal physiology of esophageal peristalsis and LES relaxation is dependent on nitrergic innervation, it has been hypothesized that achalasia naturally progresses from spastic type 3, to pan-pressurization seen in type 2 and finally to loss of esophageal pressurization in advanced type 1 achalasia. To date, there is no demonstrable longitudinal data supporting this hypothesis of disease progression. The aim of this case report is to describe novel observations that support the hypothesis of achalasia progression. We identified and reviewed the high resolution esophageal manometry studies of a patient who demonstrated a change in achalasia subtypes. We report a case of a previously healthy 60-year-old male who presented with dysphagia and was later diagnosed with type 3 achalasia by high resolution EMS (Figure 1a). He underwent two pneumatic dilatations without any significant clinical improvement of his dysphagia. Two years later, a repeat EMS demonstrated type 2 achalasia (Figure 1b). This is the first longitudinal clinical case that demonstrates the progression from type 3 to type 2 achalasia. This novel case observation strengthens our current understanding of achalasia, which involves loss of nitrergic inhibitory nerves, with progression from spastic type 3 esophageal aperistalsis to pan-esophageal type 2 pressurization. Figure 1 None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.005 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.007 | 0.004 |
| Insufficient payload (model declined to judge) | 0.006 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".