1 Diseases of Esophagus

LECTURE NO 1: DISEASES OF THE ESOPHAGUS

1. Anatomical Background

  • The esophagus is the third segment of the digestive tract.

  • Length: approximately 25 cm, located between C6 and T10.

  • Anatomical Stenosis:

    • Cricoidian

    • Broncho-aortic

    • Diaphragmatic

  • Coats of Esophagus:

    • Mucosa (stratified squamous epithelium)

    • Submucosa

    • Muscularis propria (muscle coat)

    • Adventitia

  • Motor function: conveys food and fluid from the mouth to the stomach via swallowing.

2. Esophageal Syndrome

Common Manifestations:

  • Dysphagia: difficulty swallowing, often indicated by the patient.

  • Odynophagia: retrosternal chest pain during swallowing.

  • Retrosternal Chest Pain: constrictive pain similar to angina pectoris.

  • Heartburn (Pyrosis): burning sensation in the retrosternal area.

  • Regurgitation

Special (Rare) Manifestations:

  • Dysphonia: difficulty speaking.

  • Palpitations

  • Cough

  • Signs of Neoplastic Impregnation

3. Diseases of the Esophagus

  1. Motor Disorders:

    • Achalasia

    • Diffuse esophageal spasm

    • Painful esophageal contracture

    • Gastroesophageal reflux disease (GERD)

  2. Hiatus Hernia

  3. Esophageal Diverticula

  4. Caustic Esophagitis

  5. Esophageal Varices

  6. Esophageal Cancer

  7. Mallory-Weiss Syndrome

  8. Esophageal Moniliasis

  9. Esophageal Tuberculosis

  10. Benign Esophageal Neoplasms

  11. Barrett’s Esophagus

  12. Plummer-Vinson Syndrome

4. Motor Disorders of the Esophagus

Primary Disorders:

  • Achalasia

  • Diffuse Esophageal Spasm

  • Painful Esophageal Contracture

Secondary Disorders:

  • Colagenosis:

    • Scleroderma, SLE, etc.

  • Neurologic Diseases:

    • Multiple sclerosis, stroke, etc.

  • Muscular Disturbances:

    • Myasthenia gravis

  • Infections:

    • Chagas’ disease

  • Metabolic Diseases:

    • Diabetes mellitus

  • Endocrine Disorders:

    • Myxedema, hyperthyroidism

  • Others:

    • Chronic idiopathic intestinal pseudo-obstruction, amyloidosis

5. Physiological Considerations

  • Deglutition: triggers a peristaltic wave from the pharyngo-esophageal junction.

  • Normal Motor Function: requires integrity of esophageal innervation (intrinsic and extrinsic).

  • Extrinsic Innervation: involves afferent and vagal fibers controlling swallowing.

  • Intrinsic Innervation: Auerbach plexus controls peristaltic movements.

  • Hormonal Control: various hormones (gastrin, motilin, etc.) influence the lower esophageal sphincter (LES) and esophageal motility.

6. Achalasia (Cardiospasm, Idiopathic Megaesophagus)

Definition:

  • A neuromuscular disorder of the lower esophagus.

Symptoms:

  • Dysphagia for solids.

  • Acid regurgitation and pyrosis.

  • Cough due to aspiration (30% incidence).

  • Retrosternal pain (30-60% incidence).

Diagnosis:

  • Confirmation through manometry, radiology, and endoscopy.

Treatment:

  • Medical: Anticholinergics, nitrates, Botulinum toxin.

  • Surgical: Instrumental dilation of the LES.

7. Secondary Forms of Achalasia

Causes:

  • Paraneoplasia, Chagas’ disease.

8. Hiatus Hernia

Definition:

  • Protrusion of stomach into thorax via esophageal hiatus.

Types:

  1. Sliding Hernias

  2. Rolling Hernias

  3. Mixed Type

Diagnosis & Treatment:

  • X-ray for diagnosis; treatment varies based on type.

9. Peptic Esophagitis

Etiology:

  • Due to GERD impacting esophageal mucosa.

Complications:

  • Esophagitis, peptic strictures, Barrett’s esophagus.

Diagnosis:

  • Endoscopy, esophageal manometry, biopsy; confirmed by histological exam.

10. Esophageal Diverticula

Definition:

  • Pouch-like protrusions in esophageal lining.

Types:

  • Zenker’s diverticulum (most common), midthoracic, epiphrenic.

Treatment:

  • Surgery for Zenker’s; mid-esophageal usually requires no treatment.