Other motility problems

Apart from achalasia of the oesophagus, other oesophageal motility problems include cricopharyngeal spasm and pulsion diverticulum. Traction diverticulum of the oesophagus follows infection and is rarely a problem as the mouth of the diverticulum is usually quite wide. In the case of pulsion diverticulum, however, the diverticulum forms proximal to an area of spasm and can be a cause of dysphagia. Treatment consists of removing the diverticulum but also performing a myotomy of the oesophagus below the level of the diverticulum.

A similar condition occurs with cricopharyngeal spasm when a pharyngeal pouch occurs through Killian's dehis-cence of the pharynx, generally on the left-hand side (Fig. 18.15). Treatment similarly consists of removing the pouch and dividing the cricopharyngeal muscle. This disorder most commonly occurs in elderly patients and is often associated with reflux oesophagitis which also requires attention. As there is a higher than average instance of secondary carcinoma formation at the level of the cricopharyngeal spasm, an oesophagoscopy is always required and care needs to be taken to identify the true passage which lies anteriorly; otherwise the pouch can be ruptured. In frail patients an endoscopic approach can be used to divide the cricopharyngeus muscle and widen the neck of the pouch so it drains into the oesophagus.

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