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Characteristics of Esophageal Motility and Associated Symptom Profiles in Patients with Esophageal Diverticulum: A Study Based on High-Resolution Impedance Manometry

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Abstract

Background

Esophageal diverticulum (ED) is an uncommon structural disorder with heterogenous manifestations and elusive pathophysiology. Our aim was to investigate esophageal motility and associated symptom profiles in patients with ED based on high-resolution impedance manometry (HRIM).

Methods

Consecutive patients with ED referred to our motility laboratory between 2015 to 2022 were identified in our electronic database. All patients were evaluated based on an upper endoscopy, HRIM, and standardized symptom questionnaires. Patients with ED were further stratified into upper, middle, and lower (epiphrenic) cases. Esophageal motility was evaluated with HRIM and the updated Chicago Classification v4.0.

Results

Twenty-four patients with ED (9 upper, 4 middle, and 11 epiphrenic) were analyzed. Patients with ED were generally older (mean: 65 ± 13.3 years) and predominantly women (58.3%). Most ED cases were unilaterally located (95.8%) and left-side predominant (62.5%). Mean symptom duration was 20 months (range: 1–120) and the most common symptoms were dysphagia (70.8%) and regurgitation (37.5%). Erosive esophagitis was noted in 16 patients (69.6%), while barium stasis was noted in 5 patients (20.8%). Fourteen patients (58.3%) were diagnosed with esophageal motility disorders using HRIM, with achalasia being the most common diagnosis (n = 5, 20.8%). Patients with epiphrenic diverticulum had significantly higher symptom scores and achalasia prevalence.

Conclusion

Patients with ED tended to be older and was associated with a high prevalence of EMD. A multi-disciplinary evaluation, including complete anatomical and motility surveys, may help clarify the underlying pathophysiology and tailor further treatment strategies.

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Acknowledgments

This study was supported by research grants from the National Taiwan University Hospital (NTUH 112-S0320) and the Ministry of Science and Technology (MOST 111-2314-B-002-189-MY3). The funding agencies had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would also like to thank Unit-Edit (www.uni-edit.net) for editing and proofreading this manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

    Ming-Ching Yuan & Chu-Kuang Chou

  2. Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan

    Chien-Chuan Chen, Hsiu-Po Wang & Ping-Huei Tseng

  3. Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei, Taiwan

    Jia-Feng Wu

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  1. Ming-Ching Yuan
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Yuan, MC., Chou, CK., Chen, CC. et al. Characteristics of Esophageal Motility and Associated Symptom Profiles in Patients with Esophageal Diverticulum: A Study Based on High-Resolution Impedance Manometry. Dig Dis Sci 69, 510–520 (2024). https://doi.org/10.1007/s10620-023-08196-6

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