Esophageal Disorders PDF

ESOPHAGEAL DISORDERS anEnjutniawinus KAING KIMYI, MD  OBJECTIVE  Introduction  Anatomy and function  Identify common esophageal disorders  Risk factors  Sign and symptom  Diagnostic procedures  Treatment  Complications  INTRODU...

ESOPHAGEAL DISORDERS anEnjutniawinus KAING KIMYI, MD  OBJECTIVE  Introduction  Anatomy and function  Identify common esophageal disorders  Risk factors  Sign and symptom  Diagnostic procedures  Treatment  Complications  INTRODUCTION  The esophagus is a muscular tube connecting the throat to the stomach, plays a crucial role in the digestion process.  It allows the passage of food and liquids from the mouth to the stomach, where they can be further broken down and absorbed by the body. 837  There are various factors can disrupt the normal functioning of the esophagus, leading to a range of disorders. -  ANATOMY AND FUNCTION OF THE ESOPHAGUS  Esophagus is a muscular tube-like organ that originates from endodermal primitive gut, 25–28 cm long, approximately 2 cm in diameter, located between lower border of laryngeal part of pharynx and cardia of stomach. ↓stomach  Start and end points of esophagus correspond to 6th cervical vertebra and 11th thoracic vertebra 1) mu-ini micro pa : topographically, and the gastroesophageal junction corresponds to xiphoid process of sternum  5 cm of esophagus is in the neck, and it descends over superior mediastinum and posterior mediastinum approximately 17–18 cm, continues for 1–1.5 cm in diaphragm, ending with 2–3 cm of esophagus in abdomen.  ANATOMY AND FUNCTION OF THE ESOPHAGUS The esophagus consists of several layers of tissue, including : 1. Mucosa: The innermost layer, composed of a moist, smooth lining called the epithelium. This layer protects the esophageal walls and allows for the smooth passage of food. Nonkeratinized stratified squamous epithelium of mucosa transforms simple columnar epithelium in cardia of stomach, occurring at a point called “Z line,” an irregular zigzag line. 2. Submucosa: The layer beneath the mucosa, containing connective tissue, blood vessels, and nerves. It provides structural support to the esophagus and carries the blood supply to the surrounding tissues. 3. Muscularis Propria: The middle layer composed of two sets of muscles. The inner circular muscles contract to help propel food down the esophagus during swallowing, while the outer longitudinal muscles provide additional support and help with the peristaltic movements. 4. Adventitia: The outermost layer, consisting of connective tissue that attaches the esophagus to surrounding structures such as the diaphragm and other organs.  ANATOMY AND FUNCTION OF THE ESOPHAGUS  The primary function of the esophagus is to transport food and liquids from the mouth to the stomach, allowing for further digestion and nutrient absorption. The process of swallowing involves several coordinated actions: 1. Oral Phase: Food is chewed and mixed with saliva in the mouth, forming a bolus. 2. Pharyngeal Phase: The bolus is pushed to the back of the throat and triggers a reflexive response that closes off the airway (trachea) to prevent food from entering the lungs. The upper esophageal sphincter relaxes, allowing the bolus to enter the esophagus. 3. Esophageal Phase: The peristaltic contractions of the esophageal muscles propel the food downward toward the stomach. The lower esophageal sphincter, located at the junction of the esophagus and stomach, relaxes to allow the food to enter the stomach while preventing reflux (backward flow).  IDENTIFY COMMON ESOPHAGEAL DISORDER ❖ Common esophageal disorders such as GERD, Esophagitis, Barrett's esophagus, Esophageal cancer, Esophageal stricture, Achalasia, Esophageal motility disorders.  GASTROESOPHAGEAL REFLUX DISEASE (GERD): Gastroesophageal Reflux Disease (GERD): GERD is a chronic condition characterized by the backward flow of stomach acid and digestive juices into the esophagus. This occurs due to a weakened lower esophageal sphincter (LES) or increased pressure in the stomach. Common symptoms include heartburn, regurgitation of acid or food, chest pain, and difficulty swallowing.  ESOPHAGITIS ri by gastroscopy.  Esophagitis: Esophagitis refers to inflammation of the esophagus. It can be caused by various factors, including "Fungus. GERD, infections (such as Candida or virul infection herpes), certain medications (NSAIDs), or autoimmune disorders. Symptoms may include pain or discomfort in the chest or upper abdomen, difficulty swallowing, and a feeling of food getting stuck. L  BARRETT'S ESOPHAGUS marm : offe atten esophagus. ~  Barrett's Esophagus: Barrett's esophagus is a condition in which the normal lining of the esophagus is replaced by tissue that resembles the lining of the intestine. It is often associated with long-term, untreated GERD. Barrett's esophagussamentois sen Cancer considered a precancerous condition, ~ I as it can increase the risk of developing esophageal cancer. However, not everyone with Barrett's esophagus will progress to cancer. La chinto  ESOPHAGEAL CANCER  Esophageal Cancer: Esophageal cancer refers to the development of malignant tumors in the cells lining the esophagus. It can be categorized into two main types: adenocarcinoma and squamous cell carcinoma. Esophageal cancer often presents with symptoms such as difficulty swallowing, unintended weight loss, chest pain or discomfort, and persistent coughing. Stomach. Upper Squamous Cell Cancer is a tumor that grows ~ with squamous cells and form the surface of the skin and lining of hollow organs in the body. of Stomach o in s ↑ lower Adenocarcinomas is a malignant tumor which grows in the areas to the bottom of the esophagus, and where the esophagus joins the stomach that are lined with columnar cells.  ESOPHAGEAL STRICTURE  Esophageal Stricture : An esophageal stricture refers to the narrowing of the esophagus, which can make swallowing difficult. Strictures can be caused by various factors, including long-term GERD, esophagitis, radiation therapy, or ingestion of caustic substances. Symptoms may include difficulty swallowing solids and liquids, regurgitation, and chest pain.  ACHALASIA sm N contract Furna r  Achalasia: Achalasia is a rare esophageal motility disorder characterized by the failure of the lower esophageal sphincter (LES) to relax and allow food to pass into the stomach. This results in difficulty swallowing, regurgitation of undigested food, chest pain, and unintended weight loss. Primary achalasia - degeneration of ganglion cells in myenteric plexus of esophagus -> failure of relaxation of LES/loss of peristalsis Secondary achalasia - diseases with similar Edn motor abnormalities, e.g. Chagas disease round nomr 2- (Trypanosoma cruzi parasite), amyloidosis, sarcoidosis, etc.  ESOPHAGEAL MOTILITY DISORDERS abnormalise Contract  Esophageal Motility Disorders: These disorders affect the normal rhythmic contractions (peristalsis) of the esophageal muscles, leading to swallowing difficulties and food movement issues. Examples include diffuse esophageal spasm, nutcracker esophagus, and ineffective esophageal motility.  RISK FACTORS or Gastroesophageal Reflux Disease (GERD): Obesity, hiatal hernia, smoking, alcohol consumption, and certain foods and beverages. Barrett's Esophagus and Esophageal Cancer: Chronic GERD, age, gender (more common in men), and obesity. Esophageal Stricture: Long-term untreated GERD and radiation therapy. Achalasia and Esophageal Motility Disorders: Genetic factors and autoimmune disorders. Other Factors: Certain medications, chemical exposure to corrosive substances.  SIGNS AND SYMPTOMS Difficulty swallowing (dysphagia) Heartburn or acid reflux Regurgitation of food or stomach acid Chest pain or discomfort Unintended weight loss Nausea or vomiting Chronic cough or hoarseness Feeling of food getting stuck in the throat or chest  DIAGNOSTIC PROCEDURES ❑ Upper Endoscopy (Esophagogastroduodenoscopy or EGD): In this procedure, a flexible tube with a light and camera (endoscope) is inserted through the mouth and into the esophagus, allowing the doctor to visually examine the esophageal lining and identify any abnormalities or signs of inflammation, ulcers, strictures, tumors, or Barrett's esophagus. ❑ Esophageal Manometry: Esophageal manometry measures the pressure and muscle contractions in the esophagus. It involves the insertion of a thin tube through the nose or mouth and into the esophagus. The tube contains pressure sensors that measure the strength and coordination of the esophageal muscles during swallowing. DIAGNOSTIC PROCEDURES  DIAGNOSTIC PROCEDURES ❑ Barium Swallow: During a barium swallow, the patient ingests a liquid containing barium, which coats the lining of the esophagus and stomach. X-ray images are then taken as the patient swallows, allowing the doctor to observe the structure and function of the esophagus and identify any abnormalities, such as strictures, narrowing, or abnormal motility. ❑ Esophageal pH Monitoring: Esophageal pH monitoring measures the amount of acid reflux in the esophagus over a 24-hour period. A thin tube is inserted through the nose or mouth and into the esophagus, and it is connected to a portable monitor that records pH levels. This test helps diagnose gastroesophageal reflux disease (GERD) by evaluating the frequency and duration of acid exposure in the esophagus. DIAGNOSTIC PROCEDURES  DIAGNOSTIC PROCEDURES ❑ Biopsy: A biopsy involves the removal of a small tissue sample from the esophagus for further examination under a microscope. It is typically performed during an upper endoscopy and helps identify abnormal cells, inflammation, infection, or cancerous changes. ❑ Imaging tests: Additional imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), may be used to assess the esophagus and surrounding structures, providing more detailed images for evaluation of tumors, strictures, or other abnormalities.  TREATMENT Lifestyle modifications: Dietary changes, weight management, and avoiding triggers. Medications: Antacids, proton pump inhibitors, H2 blockers, and prokinetics. Endoscopic treatments: Dilation, ablation, or stent placement. Surgery: Fundoplication, esophagectomy, or myotomy. Other therapies: Such as esophageal stenting or Botox injections for specific conditions.  COMPLICATIONS Esophageal strictures: Narrowing of the esophagus due to scar tissue formation, leading to difficulty swallowing. Barrett's esophagus: A precancerous condition characterized by changes in the lining of the esophagus, increasing the risk of esophageal cancer. Esophagitis: Inflammation of the esophagus, which can cause pain, ulcers, and difficulty swallowing. Esophageal bleeding: From ulcers, tears, or tumors in the esophagus, resulting in blood in vomit or stool. Esophageal perforation: A tear or hole in the esophageal wall, which can cause severe chest pain, infection, and life-threatening complications.  COMPLICATIONS Respiratory problems: Aspiration of stomach contents into the lungs, leading to pneumonia or respiratory distress. Malnutrition and weight loss: Difficulty in eating and inadequate nutrient absorption due to swallowing difficulties. Esophageal cancer: Long-standing untreated esophageal disorders, such as Barrett's esophagus or chronic inflammation, may increase the risk of developing esophageal cancer.