Esophageal Obstruction and Vascular Diseases

Obstructive and Vascular Diseases

• Mechanical obstruction is often discovered shortly after birth due to regurgitation during feeding.
• It is most commonly located at or near the tracheal bifurcation.
• Associated complications include aspiration, suffocation, pneumonia, fluid, and electrolyte imbalances.
• Fistulas connecting the upper or lower esophagus to a bronchus or trachea are also a feature of mechanical obstruction.

Atresia, Fistulas, and Duplications

• Various structural abnormalities affect the esophagus.

Functional Obstruction

• Characterized by incomplete LES relaxation, increased LES tone, and esophageal aperistalsis.

Achalasia

• Primary Achalasia is caused by failure of distal esophageal inhibitory neurons and degenerative changes in neural innervation.
• Secondary Achalasia can be due to conditions like Chagas disease or diabetic autonomic neuropathy.

Esophagitis

Chemical Esophagitis

• Chemical irritants causing esophagitis include alcohol, corrosive acids or alkalis, excessively hot fluids, heavy smoking, and iatrogenic factors like chemotherapy or radiation therapy.

Infectious Esophagitis

• Common infectious causes include Herpes simplex viruses, Cytomegalovirus (CMV), Candida, Mucormycosis, and aspergillosis.

Reflux Esophagitis

• Reflux of gastric contents into the lower esophagus is the most frequent cause of esophagitis.
• Associated clinical condition is termed gastroesophageal reflux disease (GERD).

Causes of GERD

• Conditions contributing to GERD include alcohol and tobacco use, obesity, pregnancy, and hiatal hernia.

Clinical Features

• GERD is most common in adults, especially those over 40 years old.
• Symptoms include heartburn, dysphagia, and regurgitation of sour-tasting gastric contents.