Achalasia associated with esophageal diverticula. Prevalence and potential implications

Although esophageal diverticula have been rarely reported in patients with achalasia, their prevalence and the potential implications of the relationship are not well known. We reviewed the medical records and the manometric and radiographic examinations in 120 patients with achalasia to determine the prevalence of esophageal diverticula and to evaluate their importance in this motility disorder. Esophageal diverticula were found in only 6 (5%) of 120 patients, and all were located in the lower half of the esophagus. Sex distribution and the prevalence of dysphagia and regurgitation, which affected all patients with diverticula and 88% of those with achalasia only, were not different significantly. Patients with esophageal diverticula were significantly older (72 vs. 52 years) than those without diverticula. In 5 of 6 patients with diverticula, mean lower esophageal sphincter (LES) pressure was 44.5 mm Hg compared to 39.1 mm Hg in 86 of 114 patients with achalasia only. Treatment by pneumatic dilatation was done in 4 patients with esophageal diverticula and in 105 patients without diverticula. Five esophageal perforations occurred, all in patients without esophageal diverticula.