Segmental hypotonic peristalsis: A sign of mid-esophageal diverticulum?

초록

Segmental dysmotility of the esophagus as well as the diagnostic entities according to the conventional manometric criteria has been known to have clinical significances. There have been some studies on esophageal segmental dysmotility, such as aperistalsis or hypertonic peristalsis, but no study has been reported regarding segmental hypotonic peristalsis (SHypoP) yet. Possible relationship between SHypoP and mid-esophageal diverticulum is presented here. 15 patients with known midesophageal diverticulum (7 had esophageal symptoms) and same number of age & sex-matched control subjects were evaluated with esophageal manometry using infusion method. Routine conventional manometry was followed by mapping manometry withdrawing the catheter cm by cm to look for any manometric change at or around the diverticulum. Conventional manometric parameters were not different between patient and control groups. According to the conventional criteria, manometric abnormalities were diagnosed in 5 cases (4: nonspecific esophageal motility disorder, 1: nutcracker esophagus) and 10 cases had normal manometry. But SHypoP was found in 6 cases (40%) (5 cases of them had normal conventional manometry) with mapping method. 5 cases had no abnormal manometric findings from either method. Prevalence of SHypoP was not different according to the different esophageal symptoms. This observation suggests that SHypoP is not infrequently found in patients with esophageal diverticulum, although its possible role for clinical symptoms and pathogenesis of diverticulum remains to be investigated. If SHypoP is found during routine manometry, a possibility of esophageal diverticulum should be considered. And mapping manometry may be useful in some cases with suspected esophageal dysmotility, including diverticulum, in case of normal conventional manometry.