{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T03:47:28Z","timestamp":1775792848171,"version":"3.50.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2009,7,9]],"date-time":"2009-07-09T00:00:00Z","timestamp":1247097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"La Fondation de France, Paris"},{"DOI":"10.13039\/100005631","name":"Foundation for Research in Thoracic Surgery","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005631","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007671","name":"Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007671","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,7,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The pathophysiology and management of epiphrenic diverticula remain controversial. This study investigated the underlying functional abnormalities and long-term results of surgical treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 &amp;lt; 0\u00b7001). After operation oesophageal diameter increased, contraction pressures decreased and peristalsis was reduced. LOS resting and gradient pressures decreased (P = 0\u00b7001). Despite unchanged acid exposure values, endoscopy revealed increased mucosal damage after operation (P = 0\u00b7003). New columnar-lined metaplasia was documented in eight patients (P = 0\u00b7013). Symptoms had decreased after a median of 61 months (P = 0\u00b7001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bjs.6652","type":"journal-article","created":{"date-parts":[[2009,7,10]],"date-time":"2009-07-10T04:46:10Z","timestamp":1247201170000},"page":"892-900","source":"Crossref","is-referenced-by-count":44,"title":["Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum"],"prefix":"10.1093","volume":"96","author":[{"given":"X B","family":"D'Journo","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Ferraro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L-Q","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Duranceau","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2009,7,9]]},"reference":[{"key":"2021070910382448000_bib1","first-page":"28","article-title":"Notes sur quelques maladies de l'oesophage","volume":"3","author":"Mondiere","year":"1833","journal-title":"Arch Gen Med Paris"},{"key":"2021070910382448000_bib2","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/00000658-200203000-00006","article-title":"Physiologic basis for the treatment of epiphrenic diverticulum","volume":"235","author":"Nehra","year":"2002","journal-title":"Ann Surg"},{"key":"2021070910382448000_bib3","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1046\/j.1365-2168.2001.01733.x","article-title":"Oesophageal diverticula","volume":"88","author":"Thomas","year":"2001","journal-title":"Br J Surg"},{"key":"2021070910382448000_bib4","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/j.1442-2050.2007.00716.x","article-title":"Assessment of a pathophysiology-directed treatment for symptomatic epiphrenic diverticulum","volume":"20","author":"Reznik","year":"2007","journal-title":"Dis Oesophagus"},{"key":"2021070910382448000_bib5","first-page":"606","article-title":"The surgical treatment of pulsion diverticula of the thoracic oesophagus","volume":"129","author":"Harrington","year":"1949","journal-title":"Ann Surg"},{"key":"2021070910382448000_bib6","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1001\/archsurg.1956.01270240130019","article-title":"Surgical treatment of lower esophageal pulsion diverticula","volume":"72","author":"Habein","year":"1956","journal-title":"AMA Arch Surg"},{"key":"2021070910382448000_bib7","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/S0022-5223(19)33167-8","article-title":"Changing concepts in the surgical treatment of pulsion diverticula of the lower oesophagus","volume":"50","author":"Allen","year":"1965","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021070910382448000_bib8","first-page":"593","article-title":"Physiopathology of lower esophageal diverticulum and its implications for treatment","volume":"151","author":"Debas","year":"1980","journal-title":"Surg Gynecol Obstet"},{"key":"2021070910382448000_bib9","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/0003-4975(93)90016-B","article-title":"Epiphrenic diverticulum: results of surgical treatment","volume":"55","author":"Benacci","year":"1993","journal-title":"Ann Thorac Surg"},{"key":"2021070910382448000_bib10","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1001\/archsurg.1992.01420050109014","article-title":"Selective use of myotomy for treatment of epiphrenic diverticula. 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