Diaphragmatic Flutter Disease: Key Findings in Esophageal Manometry and Biofeedback Treatment

Diaphragmatic flutter (DF) is a rare condition characterized by involuntary contractions of the diaphragmatic muscle, often accompanied by accessory respiratory muscle contractions. Symptoms can include epigastric pulsations, abdominal pain, and reflux. Diagnosis is challenging, and treatment is based on individual cases. This study presents the first case series of DF assessed using high-resolution esophageal manometry (HREM), electromyography (EMG), and plethysmography belts, and the symptomatic improvement through biofeedback therapy.

This case series includes patients with refractory abdominal spasms referred to the digestive motility department from 2018 to 2024.

Two patients were diagnosed with DF using HREM, which reveals a characteristic pattern of oscillating increases in intragastric pressure, repetitive crural diaphragm spasms, and pharyngeal contraction during abdominal spasms. Symptomatic control was achieved following abdomino-thoracic biofeedback (ATB) therapy by plethysmography belts.

High-resolution esophageal manometry offers a reliable, non-invasive method for diagnosis of DF, presenting a specific manometric pattern. ATB appears to be an effective treatment for DF, suggesting that voluntary but unconsciously initiated movement disorders may contribute to the condition.