Collagenous colitis — ESEGH MCQ

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HardLuminal GICollagenous colitisESEGH

A fit patient has type III achalasia with 9 cm of premature spastic contraction above the EGJ. Which definitive therapy most directly accommodates the required long myotomy?

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Correct answer: D — Peroral endoscopic myotomy at an expert centre

The best answer is “Peroral endoscopic myotomy at an expert centre”. POEM allows the myotomy length to extend proximally across the spastic segment, an advantage in type III disease. “Botulinum toxin as definitive lifelong treatment” is less appropriate because it is less durable and reserved mainly for patients unfit for definitive therapy “Nitrate tablets before meals” is less appropriate because medical relaxation is modest and temporary “Standard short pneumatic dilatation as the uniquely preferred treatment” is less appropriate because spastic disease benefits from a tailored longer myotomy “H2-receptor antagonist monotherapy” is less appropriate because acid suppression does not correct EGJ outflow obstruction

Reference: ESGE achalasia guideline: https://www.esge.com/assets/downloads/pdfs/guidelines/2020_a_1160_5549.pdf