title: Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm.
abstract: BACKGROUND
  Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter.
  
  
  METHODS
  We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm.
  
  
  CONCLUSIONS
  The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation.
  
  
  CONCLUSIONS
  In this case, the patient's symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed.
authors.affiliation: Departments of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan. Electronic address: h-matsu@med.kawasaki-m.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsumoto
authors.affiliation: Departments of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Kubota
authors.affiliation: Departments of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Higashida
authors.affiliation: Department of Laboratory Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.affiliation: Department of Gastroenterological Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
authors.affiliation: Departments of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Hirai
keywords: Diffuse oesophageal spasm; High-resolution manometry; Oesophageal epiphrenic diverticulum