Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum.
BACKGROUND
The pathophysiology and management of epiphrenic diverticula remain controversial. This study investigated the underlying functional abnormalities and long-term results of surgical treatment.


METHODS
Patients with symptoms and epiphrenic diverticula who had undergone long myotomy and Belsey Mark IV fundoplication were reviewed retrospectively. They were assessed before and after surgery by radiology, functional testing and endoscopy, and compared with a group of 40 normal volunteers.


RESULTS
The study included 23 consecutive symptomatic patients who had surgery, 20 of whom had oesophageal spastic disorders. Lower oesophageal sphincter (LOS) incoordination was considered the most constant functional abnormality (P < 0.001). After operation oesophageal diameter increased, contraction pressures decreased and peristalsis was reduced. LOS resting and gradient pressures decreased (P = 0.001). Despite unchanged acid exposure values, endoscopy revealed increased mucosal damage after operation (P = 0.003). New columnar-lined metaplasia was documented in eight patients (P = 0.013). Symptoms had decreased after a median of 61 months (P = 0.001).


CONCLUSIONS
Epiphrenic diverticulum was associated with spastic dysfunction and LOS abnormalities. A long myotomy including the LOS relieved functional obstruction and symptoms, but partial fundoplication did not prevent reflux damage.
D'Journo
X B
XB
Department of Surgery, Division of Thoracic Surgery, Université de Montréal, Montreal, Quebec, Canada.
Ferraro
P
P
Martin
J
J
Chen
L-Q
LQ
Duranceau
A
A
D000328:Adult; D000368:Aged; D004936:Diverticulum, Esophageal / Q000503:physiopathology* / Q000601:surgery; D015154:Esophageal Motility Disorders / Q000209:etiology* / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology