6. Diverticuli of the oesophagus, Achalasia

Question 1

Diverticuli types

Answer 1

1. Zenkers (upper 1/3)
2. Traction (mid 1/3)
3. Epiphrenal (lower 1/3)

Question 2

Diverticuli basics

Answer 2

Outpouching of mucosa

• true: all layers of wall
• false: mucosa only

Question 3

Zenker diverticulum

Answer 3

• Only two muscle layers
• Signs: regurgitation, aspiration pneumonia, cough
• Dg: anamnesis, clinical signs, X-ray, endoscopy
• Therapy: diverticulectomy + cricopharyngeal myotomy

Question 4

Traction diverticulum

Answer 4

• Lymphatic inflammation
• Mainly symptom free
• Surgery exceptional

Question 5

Epiphrenal diverticulum

Answer 5

• Signs: dysphagia retrosternal pain
• Dg: X-ray, endoscopy
• Therapy: only if complains - surgery

Question 6

Achalasia definition

Answer 6

failure of the lower esophageal sphincter (LES) to relax that is caused by the degeneration of inhibitory neurons within the esophageal wall

Question 7

Symptoms of achalasia

Answer 7

• Progressive dysphagia or paradoxical dysphagia
• Regurgitation of undigested food/saliva
• Weight loss

Question 8

Diagnosis of achalasia

Answer 8

• Esophageal barium swallow
• Upper endoscopy
• Esophageal manometry
• Chest X-ray -> shows mediastinum

Question 9

Treatment of achalasia (low surgical risk)

Answer 9

• Pneumatic balloon dilatation (2x - 3x)

- Oesophago-cardio-myotomy (Heller), Cardiomyotomy

Question 10

Treatment of achalasia (high surgical risk)

Answer 10

• Botulinum toxin injected in the LES

- Nitrates or Ca++ channel blockers