This document discusses various diseases and disorders of the esophagus. It begins by describing acute esophagitis, its causes including hot liquids and foreign bodies, and its symptoms of dysphagia and chest pain. It then discusses perforation of the esophagus, noting it can be caused by instrumentation or vomiting and requires early diagnosis. Corrosive burns of the esophagus from acids or alkalis are also covered. The document provides summaries of several other esophageal conditions like benign strictures, hiatal hernia, Plummer-Vinson syndrome, and motility disorders. It concludes by outlining complications of gastroesophageal reflux like esophagitis and Barrett's esophagus.

1. BIRG ANWAR UL HAQ
ENT SPECIALIST
CMH LAHORE
00923018513303

3. ACUTE OESOPHAGITIS
 It is acute inflammation of the oesophagus
 Causes
 Ingestion of
 Hot liquids
 Caustic corrosive agents
 Laceration due to swallowed foreign body
 Trauma of oesophagoscopy
 Monilial infection of oesophagus
 Systemic disorder
 Pemphigus.

4. ACUTE OESOPHAGITIS
Symptoms
 Dysphagia
 Retrosternal burning
 Haematemesis
Diagnosis
 History
 X-ray studies
 Oesophagoscopy.

5. PERFORATION OF OESOPHAGUS
 Aetiology
Instrumental trauma
 oesophagoscopy of dilatation of strictures
with bougies
Spontaneous rupture
 Follows vomiting
 involves mostly the lower third oesophagus.
Post-emetic rupture - Boerhaave's syndrome.

6. PERFORATION - DIAGNOSIS
Early diagnosis is imperative
Develops mediastinitis
Can rapidly prove fatal

7. PERFORATION - DIAGNOSIS
 Pain in the neck or interscapular region,
 Following oesophagoscopy
 The features of cervical oesophageal rupture
 Pain
 Fever
 Difficulty to swallow
 Local tenderness
 Surgical emphysema in the neck.

8. PERFORATION - DIAGNOSIS
 The features of thoracic oesophageal rupture
 Pain referred to the interscapular region
 fever 102-1 04°F(39-40°C)
 signs of shock
 surgical emphysema in the neck
 crunching sound over the heart (Hamman's sign,
 because of air in the mediastinum and pneumothorax).
 X-rays of the chest and neck are essen tial. They may
 reveal widening of the mediastinum and retrovisceral
 space, surgical emphysema, pneumothorax, pleural
effusion
 or gas under rhe diaphmgm.

9. PERFORATION - INVESTIGATIONS
 X-rays of the chest and neck are essential
 Widening of the
 Mediastinum
 Retrovisceral space
 Surgical emphysema
 Pneumothorax
 Pleural effusion
 Gas under the diaphram.

10. Treatment
 NPO
 Total parentral nutrition
 Massive doses of antibiotics
Cervical oesophagus –
 Conservative measures
 Drainage is required only if suppuration
develops

11. Treatment
Thoracic oesophagus
 Serious
 Conservative treatment rarely succeeds

12. Treatment
Within 6 hours
 Perforation is surgically closed
 Pleural cavity drained
If diagnosis is delayed
 Repair is not possible
 Drainage of the infected area.

13. CORROSIVE BURNS OF
OESOPHAGUS
Aetiology
 Acids
 Alkalies
 Other chemicals may be swallowed
accidentally by children
 Taken with the purpose of suicide in adults

14. CORROSIVE BURNS OF
OESOPHAGUS
Pathology
 Severity of oesophageal burns depends on the
 Nature of corrosive substance
 Quantity and concentration
 Duration of its contact with the oesophageal wall.
 Alkalies are more destructive and penetrate deep into
layers of the oesophagus
 Entire oesophagus and stomach may slough off
causing fatal mediastinitis and peritonitis.

15. CORROSIVE BURNS OF
OESOPHAGUS
 Oesophageal burns run through three stages:
 Stage of necrosis
 Stage of granulations
 Slough separates leaving granulating ulcer.
 Stage of stricture formation
 Stricture formation begins at 2 weeks
 continues for 2 months or longer.

16. CORROSIVE BURNS OF
OESOPHAGUS
 Evaluation of patient
 Determine the type of caustic ingested
 Signs and symptoms of shock
 Upper airway obstruction
 Mediastinitis
 Peritonitis
 Acid-base imbalance
 Associated burns of face, lips and oral cavity
 X-ray of the chest and soft tissue lateral view of
neck.

17. CORROSIVE BURNS OF
OESOPHAGUS
Management
 Hospitalize the patient.
 Treat shock
 Treat acid-base imbalance
 Monitor urine output for renal function
 Relieve pain
 Relieve airway obstruction
 Tracheostomy may be required.

19. CORROSIVE BURNS OF
OESOPHAGUS
 Neutralisation of the corrosive
 By appropriate weak acid or alkali
 Effective only if done within first 6 hours.
 Parenteral antibiotics
 Immediately
 Continued for 3- 6 weeks depending on the
degree of burns

20. CORROSIVE BURNS OF
OESOPHAGUS
 Pass a nasogastric tube
 Oesophagoscopy. - Contravertial
 with in 2 days to know
 Degree
 Extent
 Oesophagoscope is not passed beyond the first
severe circumferential burn.
 Steroids should be started
 within 48-96 hours for 4-6 weeks

21. CORROSIVE BURNS OF
OESOPHAGUS
 Oesophagogram and oesophagoscopy every
two weeks,
 If stricture develops it can be treated by
 Oesophagoscopy and prograde dilatations
 Gastrostomy and retrograde dilatation
 Oesophageal reconstruction or by-pass
 Life- long follow-up.

22. BENIGN STRICTURES OF
OESOPHAGUS
Aetiology
 Occur when muscular coat of the oesophagus
is damaged. The common causes are:
 Burns due to corrosive substances or hot
fluids.
 Trauma to oesophageal wall due to
 Impacted foreign bodies
 Instrumentation
 External injuries

23. BENIGN STRICTURES OF
OESOPHAGUS
Aetiology
Ulcerations due to reflux oesophagitis.
Ulcerations due to diphtheria, typhoid.
Sites of surgical anastomosis .
Congenital, usually in the lower third.

24. BENIGN STRICTURES OF
OESOPHAGUS
Clinical features and diagnosis
 Dysphagia
 First to solids and then to liquids
 Regurgitation
 When obstruction is complete
 Cough
 Malnourished.

25. BENIGN STRICTURES OF
OESOPHAGUS
Investigations
Barium swallow establishes the
diagnosis.
Oesophagoscopy to exclude
malignancy.

26. BENIGN STRICTURES OF
OESOPHAGUS
 Treatment
 Prograde dilatation with bougies.
 Gastrostomy
 Surgery.
 Excision of strictured segment
 Reconstruction of food passage using
 Stomach
 Colon
 Jejunum.

27. HIATUS HERNIA
 A hiatus hernia occurs when the
upper part of the stomach, which is
joined to the oesophagus moves up
into the chest through the hole
(called a hiatus) in the diaphragm.
 It is common and occurs in about 10
per cent of people.

28. HIATUS HERNIA
• Overweight
• Middle-aged
• Women and elderly people.
• It can occur during pregnancy.
• Diagnosis
• Barium meal x-rays
• Oesophgoscopy

29. HIATUS HERNIA
 Symptoms
Heartburn
Sudden regurgitation
Belching
Pain on swallowing hot fluids
Feeling of food sticking in the oesophagus

30. TREATMENT
Mainly it is surgical
Hernia is reduced
Diaphragmatic opening repaired

31. TREATMENT FOR HIATUS HERNIA
• Conservative treatment
• Early cases
• Unfit for surgery
• Sleeping with head and chest raised
• Use of drugs that reduce acidity (antacids and cimetidine)
• Losing weight
• Eating small but frequent meals
• Avoid actions which raise intra-abdominal pressure
• Avoidance of smoking
• Avoid spicy food
• Avoid hot drinks
• Avoid gassy drinks.

32. PLUMMER-VINSON SYNDROME
(PATTERSON BROWN-KELLY SYNDROME)
Classical features
 Dysphagia
 Iron-deficiency anaemia
 Glossitis
 Angular stomatitis
 Koilonychia (spooning of nails)
 Achlorhydria (atrophy of the mucous membrane)
Predominantly -females around 40

33. PLUMMER-VINSON SYNDROME
(PATTERSON BROWN-KELLY SYNDROME)
Investigations
 Barium swallow -
 Web in the post-cricoid region
 Subepithelial fibrosis
Oesophagoscopy
 Web in the post-cricoid region
 About 10% - develop post-cricoid carcinoma
 Predisposes to carcinoma
 Tongue, buccal mucosa, pharynx, oesophagus
and stomach.

34. Web

35. PLUMMER-VINSON SYNDROME
(PATTERSON BROWN-KELLY SYNDROME)
Treatment
 Correct anaemia
 Oral/parenteral iron
 Serum levels of iron are important than Hb%
 Dilatation of the web
 Oesophageal Bougies
 Oesophageal Baloons

37. GLOBUS HYSTERICUS
 Functional disorder
 Patient complains of "lump" in the throat
 No true dysphagia
 Feeling of lump is more marked between the
meals
 Rather than during a meal
 Fear of cancer in the throat.
 Clinical examination
 Pharynx, larynx and base of tongue is normal.
 Treatment is reassurance to the patient
when no cause has been found.

38. MOTILITY DISORDERS OF OESOPHAGUS
 Hypermotility disorder
 Cricopharyngeal spasm
 Diffuse oesophageal spasm
 Nut cracker oesophagus
 Hypomotility disorders
 Cardiac achalasia
 Gastro-oesophageal reflux
 May involve the
 Upper oesophageal sphincter
 Lower oesophageal sphincter
 Body of oesophagus.

39. CRICOPHARYNGEAL SPASM
 Failure of the upper oesophageal sphincter to relax properly
 Incoordination between
 Relaxation of the upper oesophageal sphincter
 Simultaneous contraction of the pharynx
 Common causes are
 Cerebrovascular accidents
 Parkinson's disease
 Bulbar polio
 Multiple sclerosis
 Muscular dystrophies.

40. DIFFUSE OESOPHAGEAL SPASM
 Strong non-peristaltic contractions of the body of
oesophagus while sphincteric relaxation is normal
 Symptoms
 Dysphagia
 Odynophagia
 Substernal chest pain - simulating angina pectoris.
 Barium swallow
 Segmented oesophageal spasms
 Rosary bead
 Cork-screw type of oesophagus,

41. DIFFUSE OESOPHAGEAL SPASM
 Manometry
 Normal relaxation of the sphincter on swallowing.
 Treatment
 Dilatation of lower oesophagus.
 Myotomy - severe cases
 From the arch of aorta to lower sphincter.

42. NUT-CRACKER OESOPHAGUS
 Strong, high amplitude oesophageal contractions
 Contractions remain peristaltic
 Spasm (contractions are non peristaltic)
Symptoms
 Dysphagia
 Substernal pain

43. CARDIAC ACHALASIA
 Absence of peristalsis in the body of oesophagus
 High resting pressure in lower oesophagal sphincter
 Lower oesophagal sphincterdoes not relax during
swallowing.
 Symptoms of cardiac achalasia
 Dysphagia,
 Which is more to liquids than solids
 Reverse of that seen in malignancy or strictures
 Regurgitation of swallowed food particularly at night.

44. CARDIAC ACHALASIA
 Diagnosis
 Barium swallow
 Dilated oesophagus with narrowed
 Rat tail lower end
 Bird-beak appearance
 Manometric studies
 Low pressure in the body of oesophagus
 High pressure at lower sphincter
 Failureof the sphincter to relax
 Endoscopy to exclude
 Benign stricture
 Development of carcinoma

45. CARDIAC ACHALASIA
 Treatment
 Modified heller's operation
 (Myotomy of the narrowed lower portion of the oesophagus).
 Forceful pneumatic dilatation of the loweroesophagus can be
done in those unfit for surgery.

46. Gastro-oesophageal Reflux
 Decreased function of lower oesophageal sphincter
 Permitting regurgitation of gastric contents into
oesophagus.
 Other causes
 Pregnancy
 Hiatus hernia
 Scleroderma
 Excessive use of tobacco
 Excessive use of alcohol
 Drugs that relax the smooth muscle
 Anticholinergic
 Beta-adrenergic drugs
 Calcium-channel blockers

47. Gastro-oesophageal Reflux
 symptoms
 Substernal Pain
 heartburn
 Regurgitation.

48. Gastro-oesophageal Reflux
Treatment
 Elevation of the head of bed at night.
 Avoiding food at least 3 hours before bed time.
 Antacids
 Drugs that increase tone of lower oesophageal
sphincter, e.g. Metoclopramide.
 H2 receptor antagonistse.g. Cimetidine and ranitidine.
 Avoiding smoking, alcohol, caffeine, chocolates, mints
and carbonated drinks.
 Antircflux surgery, e.g. Nissen's fundoplication.

49. COMPLICATIONS 0F GASTRO-OESOPHAGEAL REFLUX
Oesophageal
 Oesophagitis
 Oesophageal mucosal erosion and haemorrhage
 Benign oesophageal stricture
 Barrett's oesophagus (normal squamous epithelium of
oesophagus is replaced by columnar epithelium as a
result of continuous inflammation)
 Precancerous condition

50. COMPLICATIONS 0F GASTRO-OESOPHAGEAL REFLUX
Pulmonary
 Aspiration pneumonia
 Asthma
 Bronchiectasis

51. COMPLICATIONS 0F GASTRO-OESOPHAGEAL REFLUX
Laryngeal
 Posterior laryngitis - vague pain in throat
 Hoarseness and repeated throat clearing
 Pachydermia laryngitis
 Contact ulcers and granulomas
 Posterior glottic stenosis
 Paroxysmal laryngospasm
 Carcinoma larynx

52. COMPLICATIONS 0F GASTRO-OESOPHAGEAL REFLUX
Miscellenous
 • Globus hystencus

53. SCLERODERMA
 Systemic collagen disorder
 Primarily neural
 Secondarily weakening the smooth muscles of
 Lower two-thirds of oesophagus
 Lower oesophageal sphincter.
 Dysphagia may precede cutaneous lesions
 Barium swallow shows
 Absence of peristalsis in distal two third of oesophagus
 Many of these patients have hiatus hernia
 Reflux oesophagitis
 May develop stricture
 Distal part of the oesophagus
 Recurrent inflammatlon

54. SCHATZKI'S RING
 It occurs at the junction of
 Squamous epithelium
 Columnar epithelium
 At the lower end of oesophagus
 Called lower oesophageal ring
 Age - usually >50 years of age.
 Cause is unknown

55. SCHATZKI'S RING
Symptoms
 intermittent dysphagia
 bolus obstruction
 may be associated with hiatus hernia.
Treatment is oesophageal dilatation.

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