Esophagitis / Diverticula

A- Know the main agents responsible for caustic esophagitis and the principles of its therapeutic management:

The main agents are the bases (liquefying necrosis extent in depth), acids (most severe necrotic lesions in the stomach). Some bases are associated with a surfactant (very severe necrosis) or liquid (respiratory lesions).

The caustic ingestion required emergency hospitalization.

Avoid any maneuver required to induce vomiting, wash the upper gastrointestinal tract or administering neutralizing products.

We must clean the mouth against, calm agitation of the patient and correct hypovolemia.

The initial assessment includes seeking electrolyte disturbances or acid-base balance, an ENT examination and chest radiography.

An upper gastrointestinal endoscopy performed as soon as possible classifies lesions in 3 stages of increasing severity: inflammation or edema, ulceration and necrosis.


This classification has a great prognostic value and helps guide treatment.

The power supply can be resumed quickly in the case of a stage 1; it must be replaced with parenteral nutrition associated with antibiotic therapy in case of ulcerative lesions (stage II), responsible sequelae stenotic nearly 2 once.

In stage III, when the necrosis is diffuse esophageal resection and / or gastric must be practiced in an emergency; mortality is important.

B- Know the topographical features and principles of treatment of diverticula of the esophagus:

The pharyngoesophageal diverticulum or Zenker’s diverticulum is a diverticulum drive resulting from the protrusion of mucosa through the posterior wall of the junction pharyngoesophageal, upstream of the upper esophageal sphincter (cricopharyngeal muscle).

When large and symptomatic, needs attention due to the risk of respiratory complications.

You have to diverticulum resection in some cases associated with the cricopharyngeal myotomy.

Diverticulum of the middle third of the esophagus is due to the pull of the esophageal wall by an inflammatory process node, usually tuberculosis.

Small and large base of implantation, it does not give rise to any disorder and requires no treatment.

Diverticulum épiphrénique develops according to a neighbor mechanism Zenker’s diverticulum in the distal portion of the esophagus.

Its symptoms and its treatment usually overlap with those associated esophageal motility disorder.

C- know the main causes of non-peptic esophagitis (infectious, drug …):

Non peptic esophagitis can be infectious (Candida albicans, cytomegalovirus, herpes virus) mainly in AIDS or drug (cyclins, potassium chloride, aspirin and NSAIDs).

They may also be due to an inflammatory disease (Crohn’s disease) or food stasis in esophageal motor disorders and in the organic stenoses.