Management of Esophageal Disorders

Absence or ineffective peristalsis (muscle contractions) of the distal esophagus, combined with an inability of the esophageal sphincter to relax with swallowing.

Specialized muscles at the top and bottom of the esophagus that control the passage of food into and out of the esophagus.

Difficulty swallowing (dysphagia) for both solids and liquids, food sticking behind the esophageal sphincter, regurgitation, chest pain, and/or heartburn potentially mirroring GERD symptoms

Diagnosed via X-rays showing esophageal dilation above a narrowing at the gastroesophageal junction, potentially supplemented with barium swallows, CT scans or endoscopy

Patient instructions to eat slowly and drink fluids with meals, potentially including botulinum toxin (Botox) injection into the esophagus to relax esophageal muscles.

Difficulty swallowing.

The lower esophageal sphincter. A ring of muscle at the stomach-esophagus junction that prevents reflux.

A muscular tube connecting the pharynx (throat) to the stomach. It carries food from the mouth to the stomach.

A procedure to treat esophageal issues, often successful, but with variable long-term outcomes. Perforation is a risk.

Surgical treatment for achalasia, by cutting esophageal muscles to improve passage.

Different patterns of esophageal muscle contractions, including hypercontractile (jackhammer), uncoordinated (diffuse), and a combination with lower sphincter obstruction (type III achalasia).

Common symptoms include difficulty swallowing (dysphagia), heartburn (pyrosis), regurgitation, and chest pain resembling heart issues.

A test to measure esophageal motility and pressure, useful in assessing esophageal spasms.

First-line treatment includes calcium channel blockers and nitrates to reduce spasms. Botulinum toxin and proton pump inhibitors (PPIs) may also be utilized. Dietary adjustments and surgery are options for severe cases.

A condition where the upper stomach moves into the chest cavity through an enlarged diaphragm opening.

The most common type of hiatal hernia, where the stomach and esophagus move in and out of the chest.

Sliding (type I) hernias involve the stomach's upper portion moving up into the chest. Paraesophageal (type II) means all or part of the stomach moves alongside the esophagus.

The stomach pushes through the diaphragm beside the esophagus, potentially including other abdominal organs.

Symptoms can range from asymptomatic to severe, including pyrosis, regurgitation, dysphagia, intolerance to food, nausea, and vomiting. More serious issues like hemorrhage or obstruction can occur.

Diagnosis involves X-ray studies, barium swallow, and EGD (esophagogastroduodenoscopy).

Management includes dietary adjustments (small, frequent meals), elevating the head of the bed, and possibly surgery for symptomatic cases to relieve GERD.

Backflow of stomach contents into the esophagus, causing symptoms and/or esophageal damage.

Incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, or motility disorders can lead to excessive reflux.

Chronic irritation (like GERD), alcohol, tobacco, hot foods/drinks, and nutritional deficiencies increase esophageal cancer risk.

Adenocarcinoma (more common in African Americans) and squamous cell carcinoma are two types of esophageal cancer.

Initial symptoms include difficulty swallowing solids, a feeling of a lump in the throat, painful swallowing, and substernal pain. Later symptoms include regurgitation of food, bad breath, and hiccups.

Patients with esophageal disorders may have trouble swallowing, putting them at risk for poor nutrition and aspiration (food entering the lungs).

As esophageal cancer grows, it eventually blocks even liquid passage to the stomach.

Symptoms like heartburn, indigestion, regurgitation, difficulty swallowing, excessive saliva, and esophageal inflammation.

Ambulatory pH monitoring (gold standard), PPI trials, endoscopy, or barium swallow to check for esophageal damage.

Patient must fast for 8-12 hours before the procedure.

Avoiding triggers like smoking, alcohol, large meals near bedtime, and weight loss.

Antacids, H2 blockers, and PPIs (proton pump inhibitors) are first-line medications for symptom relief.

Lifestyle changes and medications are usually sufficient, but surgery may be necessary in extreme cases.

The muscle separating the esophagus from the stomach, important for preventing reflux.

Symptoms of esophageal cancer can include regurgitation of food and saliva, bleeding, and significant weight loss.

Imaging tests like CT scans and PET scans are used to identify esophageal cancer and potential spread to lymph nodes. Endoscopic ultrasound is used to examine the cancer's spread.

Treatment goals depend on the stage of cancer. Early stages focus on cure, while later stages prioritize symptom relief.

Treatment can involve surgery, radiation therapy, chemotherapy, or a combination of these, depending on the type of cancer and patient's condition.

A common treatment plan combines chemotherapy and radiation, followed by a period of rest, and then surgery to remove the esophagus.

After surgery, the patient is placed in a low Fowler position to facilitate breathing and reduce pressure on the surgical site, later transitioning to a standard Fowler position.

Close observation is crucial after surgery for signs of regurgitation, breathing difficulties (dyspnea), and chylothorax.

Dealing with an esophageal leak requires drainage, broad-spectrum antibiotics, and careful feeding with a NG tube.