Esophageal Diseases and Pathologies

Esophageal Diseases

• Esophageal diseases often present with similar symptoms, including:
  • Dysphagia (difficulty swallowing)
  • Heartburn (retrosternal chest pain)
  • Regurgitation of gastric contents
  • Pain
  • Hematemesis (blood in vomit)

Esophageal Pathologies

• Congenital Anomalies:
  • Esophageal atresia/fistula: Incompatible with life, often associated with tracheoesophageal fistula, leading to early feeding problems.
  • Stenosis, webs, rings: Narrowing of the esophagus due to inflammatory scarring (from reflux, radiation, or caustic injury); dysphagia is a major symptom; women are more affected in some cases.

Major Lesions with Motor Dysfunction

• Achalasia: Inability of the esophagus to relax, often primary disorder of uncertain etiology. Progressive esophageal dilatation and dysphagia (progressive difficulty swallowing) is a classic symptom. Risk of esophageal cancer.
• Hiatal Hernia: Protrusion of the stomach through the esophageal hiatus in the diaphragm. Can be sliding (common) or paraesophageal.
• Diverticulum: Outpouching of all esophageal layers (commonly called Zenker or epiphrenic diverticula).
• Mallory-Weiss Tear: Bleeding esophageal mucosa due to severe retching or vomiting (often in alcoholics).

Esophagitis

• Reflux Esophagitis (Gastroesophageal Reflux Disease): Backflow of gastric contents into the esophagus, causing mucosal injury (e.g., inflammation from acid/pepsin). Clinically, symptoms can include dysphagia, heartburn, and mucosal reddening (with cells in the basal zone).
• Barrett Esophagus: A complication of GERD where the normal squamous epithelium of the distal esophagus is replaced by columnar epithelium (intestinal metaplasia). This greatly increases risk of esophageal adenocarcinoma (e.g., 40x greater).
• Infectious/Chemical Esophagitis: Esophagitis caused by infections (e.g., Candida, Herpes simplex, cytomegalovirus (CMV) or by exposure to chemicals (e.g., alcohol, corrosives).

Esophageal Varices

• Dilated submucosal esophageal veins arising from portal hypertension. Risk of significant bleeding (e.g., hematemesis) - 40% fatalities.

Squamous Cell Carcinoma (SCC):

• This is common in the middle third of the esophagus, and less so in the lower and upper third. Dietary and environmental factors are involved. Symptoms of SCC include insidious dysphagia, weight loss, and bleeding. Nodes in the mediastinal and cervical areas can spread early, while spreading to the gastric, coeliac nodes is later.

Adenocarcinoma:

• A common cancer of the esophagus arising in the lower section/junction of the esophagus (often linked to Barrett's esophagus). Clinical presentation/features are often similar to SCC. It also tends to appear as a nodular mass with ulceration.