Chapter 22. Esophagus & Diaphragm
Esophageal achalasia is characterized by
A. Absence of esophageal peristalsis
B. Heartburn in approximately 80% of the patients
C. Low intraluminal pH due to gastroesophageal reflux
The correct answer is A. Absence of esophageal peristalsis. Esophageal manometry is the gold standard for establishing the diagnosis of esophageal achalasia. The classic manometric findings are (1) absence of esophageal peristalsis and (2) partial or absent relaxation of the LES in response to swallowing. Dysphagia for both solid and liquid food is the most common symptom, experienced by virtually every patients. Heartburn is present in about 50% of patients. The low intraluminal pH in achalasia patients it is not due to GERD, but rather to stasis and fermentation of undigested food in the distal esophagus.
Which of the following statements about Zenker diverticulum is incorrect?
A. It is the most common diverticulum of the esophagus.
B. It is a consequence of an underlying esophageal motility disorder.
C. Aspiration of diverticular contents is frequent.
D. The surgical treatment consists of lower esophageal sphincter (LES) myotomy and resection of the diverticulum or its suspension.
The correct answer is D. The surgical treatment consists of LES myotomy, resection of the diverticulum or its suspension. Although rare, Zenker diverticulum is more common than the epiphrenic diverticulum. It is a protrusion of pharyngeal mucosa through a weak zone in the Killian’s triangle, secondary to abnormalities of the UES sphincter. Dysphagia occurs very frequently. As the pouch enlarges, its contents can be inhaled into the respiratory tree causing chronic cough and pneumonia. Finally, the established treatment consists of eliminating the functional obstruction performing a UES myotomy, associated with resection or suspension of the diverticulum.
Which is the appropriate workup in a patient with suspected gastroesophageal reflux disease?
C. Upper endoscopy and 24-hour pH monitoring
D. Upper endoscopy, esophageal manometry, and 24-hour pH monitoring
The correct answer is D. Upper endoscopy, esophageal manometry, and 24-hour pH monitoring. Upper endoscopy visualizes the mucosal surface of the esophagus, determines the presence and degree of esophagitis, and allows biopsies. Esophageal manometry is mandatory to evaluate the function of both the esophageal body and LES, and is ...