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

Affiliations
  • 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

Abstract

Background/Aims
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.
Methods
We conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed.
Results
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).
Conclusions
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.

Keyword

Eckardt score; Epiphrenic diverticulum; High-resolution manometry; Integrated relaxation pressure; Megaesophagus
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