A: The embryonic foregut begins as a single tube from which the tracheobronchial diverticulum develops. B: The more proximal portion of the foregut divides into the posterior esophagus and the anterior tracheal tree. C: Septation results from ingrowth of epithelium and mesenchyme in the area of constriction. D: This ingrowth eventually forms a complete septum between the trachea and the esophagus.
• “Failure to relax” • Uncertain etiology • Risk for squamous cell carcinoma Clinical presentation – Young adulthood – Progressive dysphagia – Nocturnal regurgitation – AspirationPathologyProgressive dilation above the LESThickened muscular wallNormal or ulcerated mucosaAbsent of myenteric ganglia at the body
Manometer • Aperitalsis • Partial or incomplete relaxation of the LES with swallowing • Increased resting tone of the LESManometry
A multifactorial disorderA lower mean LES resting pressure Increased gastric volume/ pressureMuscle weakness after mealsScleroderma-like diseases pyloric obstructionMyopathy gastric stasisPregnancy during acid hypersecretion statesSmoking ObesityMedications PregnancySurgical damage to the LES AscitesEsophagitis tight clothes Transient relaxation of LES Inadequate or slowed clearance of refluxed material Delayed gastric emptying Reflux of both acid and alkaline secretions
Reference• Abbas K and Aster F, Robbin and Cotran pathologic basis of disease. 8th edition. Saunders Elsevier, Philadelphia, 2010• Rubin R and Strayer DS, Rubin’s pathology: clinicopathologic foundations of medicine .6th edition. Lippincott Company, China, 2012• Noffsinger AE, Stemmermann GN, Lantz PE and Isaacson PG. Gastrointestinal pathology an atlas and text. 3rd edition. Lippincott Company, Philadelphia, 2008