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.
Similar content being viewed by others
References
Farrokhi F, Vaezi MF. Idiopathic (primary) achalasia. Orphanet J Rare Dis. 2007;2:38.
Sato H, Yokomichi H, Takahashi K, et al. Epidemiological analysis of achalasia in Japan using a large-scale claims database. J Gastroenterol. 2019;54:621–7.
Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(Suppl 1):57–65.
Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–33.
Japan Esophageal Society. Descriptive rules for achalasia of the esophagus. Esophagus. 2017;14(4):275–89.
Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.
Shiwaku H, Inoue H, Sato H, et al. Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan. Gastrointest Endosc. 2020;91:1037–44.
Lee Y, Brar K, Doumouras AG, et al. Peroral endoscopic myotomy (POEM) for the treatment of pediatric achalasia: a systematic review and meta-analysis. Surg Endosc. 2019;33:1710–20.
Inoue H, Shiwaku H, Iwakiri K, et al. Clinical practice guidelines for peroral endoscopic myotomy. Dig Endosc. 2018;30:563–79.
Albers D, Frieling T, Dakkak D, et al. Peroral endoscopic myotomy (POEM) is effective in treatment of noncardiac chest pain caused by hypercontractile esophageal motility disorders: results of the POEM-HYPE-Study. Z Gastroenterol. 2018;56:1337–42.
Chandan S, Mohan BP, Chandan OC, et al. Clinical efficacy of per-oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta-analysis. Surg Endosc. 2020;34:707–18.
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders. Neurogastroenterol Motil. 2015;27(2):160–74.
Kuribayashi S, Iwakiri K, Kawada A, et al. Variant parameter values-as defined by the Chicago Criteria-produced by ManoScan and a new system with Unisensor catheter. Neurogastroenterol Motil. 2015;27:188–94.
Iwakiri K, Hoshihara Y, Kawami N, et al. The appearance of rosette-like esophageal folds (“esophageal rosette”) in the lower esophagus after a deep inspiration is a characteristic endoscopic finding of primary achalasia. J Gastroenterol. 2010;45(4):422–5.
Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103:1732–8.
Pandolfino JE, Ghosh SK, Rice J, et al. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol. 2008;103:27–37.
Vaezi MF, Pandolfino JE, Yadlapati RH, et al. ACG Clinical guidelines: diagnosis and management of Achalasia. Am J Gastroenterol. 2020;115:1393–411.
Sato H, Takahashi K, Mizuno K-i, et al. Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology. J gastroenterol. 2018;53:484–93.
Sodikoff JB, Lo AA, Shetuni BB, et al. Histopathologic patterns among achalasia subtypes. Neurogastroenterol Motil. 2016;28:139–45.
Nicodeme F, de Ruigh A, Xiao Y, et al. A comparison of symptom severity and bolus retention with Chicago classification esophageal pressure topography metrics in patients with achalasia. Clin Gastroenterol Hepatol. 2013;11:131–7.
Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology. 2013;145:954–65.
Ponds FA, Bredenoord AJ, Kessing BF, et al. Esophagogastric junction distensibility identifies achalasia subgroup with manometrically normal esophagogastric junction relaxation. Neurogastroenterol Motil. 2017. https://doi.org/10.1111/nmo.12908.
Pandolfino JE, Kwiatek MA, Ho K, et al. Unique features of esophagogastric junction pressure topography in hiatus hernia patients with dysphagia. Surgery. 2010;147:57–64.
Tanaka Y, Ihara E, Nakamura K, et al. Clinical characteristics associated with esophageal motility function. J Gastroenterol Hepatol. 2016;31:1133–40.
Kawami N, Hoshino S, Hoshikawa Y, et al. Validity of the cutoff value for integrated relaxation pressure used in the starlet high-resolution manometry system. J Nippon Med sch. 2019;86:327–35.
Roman S, Kahrilas PJ. Distal esophageal spasm. Curr Opin Gastroenterol. 2015;31:328–33.
Roman S, Pandolfino JE, Chen J, et al. Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT). Am J Gastroenterol. 2012;107:37–45.
van Hoeij FB, Smout AJ, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2015;27:1310–6.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Conflict of interest
All authors have no conflict of interest.
Informed consent
Informed consent was obtained in the form of an opt-out system on a website.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-021-00875-5