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Characteristics of patients with esophageal motility disorders on high-resolution manometry and esophagography—a large database analysis in Japan

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Abstract

Background

With the development of high-resolution manometry (HRM) and peroral endoscopy, more patients with esophageal motility disorders (EMDs) including achalasia are diagnosed and treated. The characteristics of Japanese patients with EMDs are unknown and should be elucidated.

Methods

A large-scale database analysis was performed at seven high-volume centers in Japan. EMDs between 2010 and 2019 were analyzed.

Results

A total of 1900 patients were diagnosed with treatment naïve achalasia on esophagography. A long disease history was related to the sigmoid and dilated esophagus, and patients’ symptom severity declined as achalasia progressed to the sigmoid type.

Among 1700 patients received starlet HRM, 1476 (86.8%) completed the examination. Long disease history and sigmoid achalasia were identified as risk factors for the failure of HRM examination. Type I achalasia was the most common type found on starlet HRM, and 45.1% of patients with achalasia had lower esophageal sphincter (LES) pressure within the normal range. Type III had a high age of onset and mild symptom severity, compared to the other two subtypes. Type III achalasia, esophagogastric outflow obstruction (EGJ-OO), jackhammer esophagus (JE), and diffuse esophageal spasm (DES) were relatively rare compared to type I–II achalasia. The clinical characteristics of EGJ-OO, JE, and DES were generally close to those of achalasia.

Conclusion

This first large-scale database analysis indicates that more Japanese patients with achalasia are type I and have a normal range of LES pressure on starlet HRM. Failure of HRM is not rare; therefore, esophagography continuously has a complementary role in achalasia diagnosis.

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Authors and Affiliations

  1. Department of Surgery, Tohoku University School of Medicine, 1-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Chiaki Sato & Takashi Kamei

  2. Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

    Hiroki Sato

  3. Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan

    Yuto Shimamura & Haruhiro Inoue

  4. Department of Gastroenterology, Kobe University Hospital, Kobe, Japan

    Shinwa Tanaka

  5. Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Hironari Shiwaku

  6. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan

    Junya Shiota

  7. Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan

    Ryo Ogawa

  8. Department of Health Sciences, University of Yamanashi, Yamanashi, Japan

    Hiroshi Yokomichi

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  1. Chiaki Sato
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  10. Haruhiro Inoue
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Correspondence to Chiaki Sato.

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Ethical Statement

Ethics committee approval was obtained from each facility (Tohoku University Hospital Approval No 2020–1-060) and was conducted according to the tenets set by the Declaration of Helsinki.

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Sato, C., Sato, H., Kamei, T. et al. Characteristics of patients with esophageal motility disorders on high-resolution manometry and esophagography—a large database analysis in Japan. Esophagus 19, 182–188 (2022). https://doi.org/10.1007/s10388-021-00875-5

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  • DOI: https://doi.org/10.1007/s10388-021-00875-5

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