This document discusses the anatomy, physiology, and diagnosis of oesophageal diseases. It covers the surgical anatomy of the oesophagus, its physiology during swallowing, common symptoms of oesophageal diseases, and investigations used in diagnosis including barium swallow, endoscopy, endosonography, manometry, and pH monitoring. It also discusses specific oesophageal diseases and conditions such as congenital lesions, benign tumors, cancer, foreign bodies, perforations, gastroesophageal reflux disease, hiatal hernia, and motility disorders.

1. Anatomy, Physiology
and Diagnosis of
Oesophageal Diseases
BIRG ANWAR UL HAQ
ENT SPECIALIST
CMH LAHORE

2. LEARNING OBJECTIVES
• Anatomy of oesophagogus and
its relationship to disease
• Physiology of the oesophagus
and its relationship to disease.
• Clinical features
• Investigations
• Treatment of benign and
malignant disease

3. TOPICS
• Surgical anatomy
• Physiology
• Symptoms
• Investigations
• Congenital lesions:
TOF and Atresia
Benign tumours.
Cancer of oesophagus
Others.
• Foreign bodies.
• Oesophageal
perforation.
• Gastro-oesophageal
reflux diease.
• Hiatal hernia.
• Oesophageal motility
disorders: achalasia and
diffuse spasm.
• Oesophgeal diverticula.

4. SURGICAL ANATOMY
• Fibromuscular tube
• Length - 25 cm.
• Occupies posterior mediastinum.
• Extention
– From the cricopharyngeal sphincter
–To cardia of the stomach

5. SURGICAL ANATOMY
• 4 cm of this tube lies below the diaphragm.
• The musculature
–Upper 1/3 - striated
–Lower 2/3 - smooth muscle below.
• It is lined by squamous epithelium except the
lower 3 cms which are lined by specialized
mucosa.

6. ANATOMY

10. Wall of Oesophagus

12. PHYSIOLOGY
• Function
–To transfer food
• from the mouth
• to the stomach.
• Sequence of events in Oropharynx
–Sequential contraction of oropharyngeal
musculature
–simultaneous closure of nasal
–Clouser of respiratory passages

13. PHYSIOLOGY
– opening of the cricopharyngeal sphincter.
• The upper sphincter is normally closed at rest to
prevent regurgitation
• Failure of it to relax on swallowing may cause
propulsion diverticulum
• Involuntary peristaltic wave in the body of
oesophagus then sweeps food bolus downwards.
• Relaxation of gastro-oesophageal sphincter

14. SYMPTOMS
• Difficulty in swallowing
• Feeling of food or fluid sticking (oesophageal dysphagia)
– Must rule out malignancy.
• Pain on swallowing ( odynophagia)
– Suggest inflamation and ulceration
• Regurgitation or reflux ( heartburn)
– Common in gastro-oesophageal reflux disease (
GORD).

15. SYMPTOMS
• Chest pain
– Difficult to distinguish from cardiac pain.
• Loss of weight
• Anaemia
• Cachexia
• Change of voice

16. • E:PRESENTATIONSAnimationsSWALLOWING
Swallowing (deglutition) .flv

17. INVESTIGATIONS
• Radiography.
– Plain CXR
– Contrast oesophagography ( barium or
gastrographin swallow)
– CT scan of chest.
• Endoscopy
– Rigid
– Flexible oesophagoscopy.

18. INVESTIGATIONS
• Endosonography:
– Endoscopic ultrasonography.
• Oesophageal manometry
– To diagnose oesophageal motility disorders.
• 24-hour ph monitoring:
– The most accurate method for the diagnosis of
gastro-oesophageal reflux
• Hb%

19. PHYSIOLOGY
• Lower end of the oesophagus
– Physiological sphincter
• Prevent reflux of gastric acid and bile.
• The tone of this sphincter is influenced by
– Gastrointestinal hormones
– Anti-cholinergic drugs
– Smoking
• The displaced sphincter loses its tone and permits
reflux to occur
• GOJ- 3-4 cm long
• GOJ pressure of 30 cm h2o.

20. BARIUM SWALLOW

21. • E:PRESENTATIONSAnimationsSWALLOWING
Barium Swallow.flv

22. ENDOSONOGRAPHY

23. ENDOSCOPY
• Rigid Oesophagoscopy
• Flexable Oesophagus

24. RIGID OESOPHAGOSCOPY

31. FLEXABLE ESOPHAGOSCOPY

34. FLEXIBLE OESOPHAGOSCOPY
• Advantages
– OPD procedure
– LA – spray/SLN block
– Less morbidity
– Can be done in jaw, spine disorders
– Can examine stomach and duodenum
– Good illumination and magnification
• Disadvantages
– Limited removal of FB
– Cant examine laryngopharynx
– Need voluntary swallowing to advance
scope