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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：食管憩室（ED）是一种罕见的结构性疾病，具有异质性表现和难以捉摸的病理生理学。我们的目的是基于高分辨率阻抗测压（HRIM）研究ED患者的食管运动和相关症状特征。
方法：在我们的电子数据库中确定了2015年至2022年期间到我们的动力实验室转诊的连续ED患者。所有患者均根据上消化道内窥镜检查进行评估，HRIM,和标准化症状问卷。ED患者进一步分层为上，中间,和较低的（顿音）病例。用HRIM和更新的芝加哥分类v4.0评估食管运动性。
结果：24例ED患者（9例，4个中间，和11个顿性)进行了分析。ED患者通常年龄较大（平均：65±13.3岁），主要是女性（58.3％）。大多数ED病例位于单侧（95.8％）和左侧（62.5％）。平均症状持续时间为20个月（范围：1-120），最常见的症状是吞咽困难（70.8％）和反流（37.5％）。16例患者出现糜烂性食管炎（69.6%），5例患者（20.8%）出现钡淤滞。14例患者（58.3％）使用HRIM诊断为食管运动障碍，门失弛缓症是最常见的诊断（n=5，20.8%）。上膈憩室患者的症状评分和贲门失弛缓症患病率明显较高。
结论：ED患者往往年龄较大，并且与EMD的高患病率相关。多学科评估，包括完整的解剖学和运动性调查，可能有助于阐明潜在的病理生理学，并制定进一步的治疗策略。
方法：在我们的电子数据库中确定了2015年至2022年期间到我们的动力实验室转诊的连续ED患者。所有患者均根据上消化道内窥镜检查进行评估，HRIM,和标准化症状问卷。ED患者进一步分层为上，中间,和较低的（顿音）病例。用HRIM和更新的芝加哥分类v4.0评估食管运动性。
结果：24例ED患者（9例，4个中间，和11个顿性)进行了分析。ED患者通常年龄较大（平均：65±13.3岁），主要是女性（58.3％）。大多数ED病例位于单侧（95.8％）和左侧（62.5％）。平均症状持续时间为20个月（范围：1-120），最常见的症状是吞咽困难（70.8％）和反流（37.5％）。16例患者出现糜烂性食管炎（69.6%），5例患者（20.8%）出现钡淤滞。14例患者（58.3％）使用HRIM诊断为食管运动障碍，门失弛缓症是最常见的诊断（n=5，20.8%）。上膈憩室患者的症状评分和贲门失弛缓症患病率明显较高。
结论：ED患者往往年龄较大，并且与EMD的高患病率相关。多学科评估，包括完整的解剖学和运动性调查，可能有助于阐明潜在的病理生理学，并制定进一步的治疗策略。
