German Diagnostic Clinic Helios Clinic Wiesbaden, Germany
Department of Gastroenterology, German Diagnostic Clinic Helios Clinic Wiesbaden, Germany
Thank you for the opportunity to allow us to address the comments and concerns raised by Sakin et al . I appreciate the time they took to read and voice their concern on the present review article.
I understand and share the concerns of Sakin et al  that with the right conventional manometry catheter (8 pressure sensors) a positioning of pressure sensors in the esophageal body to evaluate the body motility is not necessary. However, in this review article the principle of the procedure as it is used in our clinic was described. Certainly, there are variations depending on the manometry catheter (number of pressure sensors) used which can increase the effort in the measurement of the body motility.
Sakin et al  pointed out that for the diagnosis of achalasia with high-resolution manometry (HRM) the measurement of the median integrated relaxation pressure (IRP) rather than a mean IRP was recently recommended by the International HRM Working Group . At the time of writing, the mentioned recommendation was not published yet, and, to my knowledge, most of the used HRM systems still calculate the mean IRP, which should be changed in the future. I am grateful for the note because it highlights the importance of integrating such new recommendations on a rapidly changing subject.
Furthermore, Sakin et al  emphasize the fact that esophagogastric junction outflow obstruction may be an achalasia variant, but also has several other potential etiologies including esophageal stiffness as a result of infiltrative disease or cancer, as mentioned in the part ‘Differential diagnosis of abnormal lower esophageal sphincter relaxation’ .
1. Sakin YS, Kekilli M, Uygun A, Bagci S, Letter to the editor. New diagnostic approach to diagnosis of achalasia after recent Chicago classificationAnn Gastroenterol 2015; 28: 410.
2. Kahrilas PJ, Bredenoord AJ, Fox M, International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0Neurogastroenterol Motil 2015; 27: 160-174.
3. Müller M, Impact of high-resolution manometry on achalasia diagnosis and treatmentAnn Gastroenterol 2015; 28: 3-9.