J Neurogastroenterol Motil.  2022 Apr;28(2):222-230. 10.5056/jnm21188.

Development of Dilated Esophagus, Sigmoid Esophagus, and Esophageal Diverticulum in Patients With Achalasia: Japan Achalasia Multicenter Study

  • 1Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
  • 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
  • 3Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
  • 4Department of Gastroenterology, Kobe University Hospital, Hyogo, Japan
  • 5Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
  • 6Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
  • 7Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Miyagi, Japan
  • 8Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  • 9Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
  • 10Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • 11Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
  • 12Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
  • 13Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
  • 14Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
  • 15Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine, Tottori, Japan
  • 16Department of Health Sciences, University of Yamanashi, Yamanashi, Japan


Patients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, and develop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation.
We conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed.
Straight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration (P = 0.005) with low integrated relaxation pressure values (P = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED (P = 0.022).
The etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.


Eckardt score; Epiphrenic diverticulum; High-resolution manometry; Integrated relaxation pressure; Megaesophagus
Full Text Links
  • JNM
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr