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

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  • Hiroki Sato
    Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
  • Yusuke Fujiyoshi
    Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
  • Hirofumi Abe
    Department of Gastroenterology, Kobe University Hospital, Hyogo, Japan
  • Hironari Shiwaku
    Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
  • Junya Shiota
    Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
  • Chiaki Sato
    Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Miyagi, Japan
  • Hiroyuki Sakae
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  • Masaki Ominami
    Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Yoshitaka Hata
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Hisashi Fukuda
    Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
  • Ryo Ogawa
    Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
  • Jun Nakamura
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
  • Tetsuya Tatsuta
    Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
  • Yuichiro Ikebuchi
    Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine, Tottori, Japan
  • Hiroshi Yokomichi
    Department of Health Sciences, University of Yamanashi, Yamanashi, Japan
  • Shuji Terai
    Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
  • Haruhiro Inoue
    Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan

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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 (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.

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