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1. OESOPHAGUS BIZARRE
Представлено:-Пател Дхрувел
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2. The oesophagus is a muscular tube that connects the throat to
the stomach. It is responsible for transporting food and liquids
from the mouth to the stomach for digestion. A bizarre
oesophagus is a term used to describe an abnormalityor
anomaly in the structure or function of the oesophagus.
DEFINATION

3. 1. Esophageal webs:Thinmembranes that grow across the insideof the esophagus,
causingnarrowingand difficulty swallowing.
2. Esophageal rings:Narrow bands of tissuethat form around the esophagus,
causingdifficulty swallowing.
3. Esophageal diverticula:Pouches or sacs that protrude from the walls of the
esophagus, causingdifficulty swallowingand regurgitationof food.
4. Achalasia:A conditionwhere the muscles of the lower esophageal sphincter
(LES) fail to relax properly, causingdifficulty swallowingand regurgitationof
food.
5. Barrett's esophagus:A condition wherethe liningof the esophagus changes and
becomes more like the lining of the stomach, increasingthe riskof esophageal
cancer.
TYPES OF BIZARRE ESOPHAGUS

4. ESOPHAGEAL WEBS
Esophageal webs are developmentalanomalies characterized by one or more thin horizontal
membranes of stratified squamous epithelium within the upper (cervical) esophagus and
midesophagus.Unlike rings these anomalies rarely encircle the lumen but instead protrude
from the anterior wall, extending laterally but not to the posterior wall. Webs are common in
the cervical esophagus and are best demonstrated on an esophagogram with the lateral view.
In up to 5% of cases they are identified in an asymptomatic state, but when they are
symptomatic they cause dysphagia for solids. Webs are fragile membranes and so respond
well to esophagealbougienage with mercury-weighteddilators.
An association among cervical esophagealwebs, dysphagia, and iron deficiency anemia in
adults has been described as the Plummer-Vinson or Paterson-Kelly syndrome.44 The
syndrome, although uncommon, occurs primarily in women. Recent reports have shown an
association between Plummer-Vinson syndrome and celiac disease.45 It is an important
syndrome because it identifies a group of patients at increased risk for squamouscarcinoma
of the pharynx and esophagus.44 Correction of iron deficiency in Plummer-Vinson syndrome
may result in resolution of the associated dysphagia as well as disappearance of the web.

5. Congenital Esophageal Webs
Congenital esophageal webs are relatively uncommon and
can be located at any level. If the web is complete and totally
excludes the lumen, it will present as a form of esophageal
atresia. These are thought to be secondary to failure
of recanalization of the primitive foregut. Single webs are
more common than multiple webs.
Acquired Esophageal Webs
Acquired webs, found in both children and adults, are secondary
to a variety of causes. Most are postcricoid.The true incidence
of acquired webs is unknown, as 95% are asymptomatic. Webs
are found in approximately 6–14% of barium examinations of
the upper gastrointestinal tract and diagnosis can be made by
both upper GI barium study and endoscopy. The common clinical
complaint is intermittentdysphagia for solid foods, alternating
with long periods of normal swallowing. Dysphagia is most likely if the web narrows
the lumen to less than 13 mm in diameter.

6. A Schatzki ring or Schatzki–Gary ring is a narrowing of the
lower esophagus that can cause difficulty swallowing (dysphagia). The
narrowing is caused by a ring of mucosal tissue (which lines the
esophagus) or muscular tissue. A Schatzki ring is a specific type of
"esophageal ring", and Schatzki rings are further subdivided into those
above the esophagus/stomach junction (A rings),and those found at the
squamocolumnar junction in the lower esophagus (B rings).
Patients with Schatzki rings can develop intermittent difficulty
swallowing or, more seriously, a completely blocked esophagus.
SCHATZKI RING ESOPHAGEAL RINGS

7. SIGNS AND SYMPTOMS
Not all patients with Schatzki rings have symptoms; barium swallow tests of the
esophagus sometimes show Schatzki rings in patients with no swallowing
difficulties. When Schatzki rings cause symptoms, they usually result in
episodic difficulties with swallowing (dysphagia) solid foods, or a sensation that
the food "sticks" while swallowing, especially if the food is not chewed
thoroughly. Patients usually are able to regurgitate or force through the food
material and resume eating. However, complete obstruction of the esophagus
by a bolus of food (often called steakhouse syndrome) can occur. This can
cause crushing chest pain and may need immediate treatment with endoscopy,
which is the use of a specialized fibre-optic camera in order to remove the
lodged food.[4] After the obstruction is located, snares or forceps are inserted to
pull the food out of the esophagus or to push it into the stomach.

8. Endoscopic image of Schatzki ring,
seen in the esophagus with
the gastro-esophageal junction in the
background.
DIAGNOSIS
A Schatzki ring is usually diagnosed
by esophagogastroduodenoscopy or barium
swallow. Endoscopy usually shows a ring
within the lumen of the esophagus which can
be of variable size (see picture). The ring is
usually located a few centimetres above
the gastro-esophageal junction, where the
esophagus joins the stomach. Schatzki rings
can often resemble a related entity called
an esophageal web.

9. TREATMENT
Asymptomatic Schatzki rings seldom worsen over time, and need no
treatment.SymptomaticSchatzki rings may be treated with esophageal
dilatation,using bougie or balloon dilators. These have been found to be
equally effective.[8] Bougie dilatation involves passage of long dilating tubes of
increasing size down the esophagus to stretch the area of narrowing, either
over a guidewirepassed into the stomach by endoscopy (the Savary-
Gillard system)or using mercury-weighteddilators (the Maloney system).
This is usually done with intravenous sedation to reduce discomfort.
Dilatation can produce some temporary irritation. A short course of proton
pump inhibitor therapy may decrease aggravation by stomach acid reflux into
the esophagus. The duration of the benefit of dilation varies, but may be from
months to years. Dilation may be repeatedif narrowing recurs.

10. The diverticulum is the protrusion of the wall
of the hollow organ ( diverticulum branch from
the main path).
ESOPHAGEAL DIVERTICULA
Diverticular disease can present with painless
rectal bleeding as bright red blood per rectum.
Diverticular bleeding is the most common
cause of acute lower gastrointestinal
bleeding.However, it is estimated that 80% of
these cases are self-limiting and require no
specific therapy.

11. Esophageal diverticulumis a pouch that
protrudes outward in a weak portion of
the esophageal liningand is usually
asymptomatic 1. This pocket-like
structurecan appear anywherein the
esophageal lining betweenthe throat and
stomach.
Esophageal diverticulumcan affect
people of all ages, although most cases
occur in middle-aged and elderly
individuals.
Overall, esophageal diverticulumis rare,
showingup in less than 1 percent of
upper gastrointestinalX-rays and
occurring in less than 5 percent of
patients who complain of difficulty in
swallowing(dysphagia)2. Esophageal
diverticulaare found in approximately
1% to 3% of those presentingwith
dysphagia. It can occur in all ages but are
typically diagnosedin the elderly.
Esophageal diverticulumis usually found
more in men than in women.
Typically, esophageal diverticulum is a
nuisancethat enlarge slowly over many
years, gradually producingincreasing
symptoms, such as difficulty in
swallowing(dysphagia), regurgitation
and aspirationpneumonia, caused by
breathingin regurgitateddiverticulum
content. Patients typically present when
they have symptoms of regurgitationor
dysphagia.

13. ACHALASIA
Achalasia is a rare swallowing disorder that affects the esophagus (the
tube between the throat and the stomach). In people with achalasia, the
esophagus muscles do not contract properly and do not help propel food
down toward the stomach. At the same time, the ring of muscle at the
bottom end of the esophagus, called the lower esophageal sphincter (LES),
is unable to relax to let the food into the stomach. The causes of achalasia
are unknown, but researchers are exploring several theories. One is
related to degeneration of the nerve cells located between the layers of
esophageal muscles. These nerve cells enable the esophagus to push food
towardand into the stomach.
Some studies suggest a possible relationship between achalasia and
parasitic or viral infections. People with achalasia may be more likely to
show evidence of previous infections, such as antibodies to the herpes
simplexvirus, human papillomavirus, measles virus and others.

14. During myotomy, a gastroenterologist
cuts the muscles in the esophagus,
esophageal sphincterand lower stomach
to prevent them from tightening.
An achalasia myotomy can be performed
through the mouth with an endoscope
(peroral endoscopic myotomy or POEM)
or through several small incisions in the
abdomen (laparoscopic Heller myotomy).
A lower esophageal sphinctermyotomy
disrupts just enough muscle to relieve
achalasia symptoms but not enough to
cause acid reflux. This is the most permanent solution for achalasia, but it is not
appropriate for all patients.
Achalasia Surgery — Esophageal
Myotomy

15. ACHALASIA DIAGNOSIS
In addition to a thorough physical examination and review of your medical history and
symptoms, your doctor may recommend the following tests to help diagnose achalasia.
•Pharyngeal and esophageal manometry to measure and record changes in pressure
throughout the throat and esophagus as you swallow. Some consider manometry to be
the most reliable test for achalasia, since it can detect the location and severity (or lack
of) muscle contractions that affect the ability to swallow.
•Upper endoscopy to examine the esophagus and stomach using an endoscope — a thin
tube with a camera that is inserted through the mouth. This test helps see abnormalities
in the esophagus such as strictures (narrowing) and tumors. During endoscopy, your
doctor can perform a biopsy or remove abnormal tissue for further analysis.
•Wireless pH testing or 24-hour pH impedance testing to evaluate the acidity in the
esophagus during an extended period and rule out other conditions such as GERD.
•Barium swallow, an imaging test that uses the contrast medium barium and X-rays to
create images of the upper gastrointestinal (GI) tract. This test may reveal a dramatic
narrowing of the esophagus, which is sometimes called an achalasia bird beak.

16. Barrett's esophagus is a condition in which the flat pink liningof the
swallowingtube that connects the mouth to the stomach (esophagus)
becomes damaged by acidreflux, which causes the liningto thickenand
become red.
Betweenthe esophagus and the stomach is a critically important valve,
the lower esophageal sphincter(LES). Over time, the LES may beginto
fail, leading to acid and chemical damage of the esophagus, a condition
called gastroesophagealreflux disease(GERD). GERD is often
accompanied by symptoms such as heartburn or regurgitation. In some
people, this GERD may trigger a change in the cells liningthe lower
esophagus, causingBarrett's esophagus.
BARRETT'S ESOPHAGUS

17. Endoscopy is generally used to determine if you have Barrett's
esophagus.
A lighted tube with a camera at the end (endoscope) is passed
down your throat to check for signs of changing esophagus
tissue. Normal esophagus tissue appears pale and glossy. In
Barrett's esophagus, the tissue appears red and velvety.
Your doctor will remove tissue (biopsy) from your esophagus.
The biopsied tissue can be examined to determine the degree
of change.
DIAGNOSIS

18. SCREENING FOR BARRETT'S ESOPHAGUS
The Gastroenterology says screening may be recommended for men who have
had GERD symptoms at least weekly that don't respond to treatment with proton pump inhibitor
medication, and who have at least two more risk factors, including:
•Having a family history of Barrett's esophagus or esophageal cancer
•Being male
•Being white
•Being over 50
•Being a current or past smoker
•Having a lot of abdominal fat
While women are significantly less likely to have Barrett's esophagus, women should be screened
if they have uncontrolled reflux or have other risk factors for Barrett's esophagus.

20. The diagnosis of bizarre oesophagus
depends on the type of anomaly present.
A doctor may order several tests to
diagnose the condition, including:
1. Endoscopy: A procedure where a
flexible tube with a camera is inserted
into the esophagus to examine its
structure and look for abnormalities.
2. Barium swallow: A test where a
patient swallows a liquid containing
barium, which shows up on X-rays
and helps the doctor see any
narrowing or blockages in the
esophagus.
3. Manometry: A test that measures the
pressure and strength of the muscles
in the esophagus, which can help
diagnose conditions like achalasia.
4. Biopsy: A procedure where a small
tissue sample is taken from the
oesophagus and examined under a
microscope to look for abnormal cells
or tissue.Once a diagnosis of bizarre
esophagus is made, the doctor will
work with the patient to develop a
treatment plan based on the type and
severity of the anomaly. Treatment
options may include medications,
surgery, and lifestyle changes.
DIAGNOSIS OF BIZARRE ESOPHAGUS

21. Preventing esophageal disorders and their bizarre effects on the body involves
maintaining a healthy lifestyle and seeking medical care for any symptoms that
may indicate an issue with the esophagus. Here are some general prevention tips:
1. Maintain a healthy weight: Excess weight can contribute to conditions such
as GERD, which can lead to esophageal issues. Eating a balanced diet and
getting regular exercise can help prevent obesity and related health problems.
2. Avoid smoking and excessive alcohol consumption: Both smoking and heavy
alcohol use can increase the risk of esophageal cancer and other esophageal
disorders. Quitting smoking and moderating alcohol intake can help reduce
this risk.
3. Manage acid reflux: If you experience frequent heartburn or acid reflux, it's
important to manage these symptoms to prevent damage to the esophagus.
This may involve dietary changes, avoiding trigger foods, and using over-the-
counter or prescription medications as recommended by a healthcare
provider.
PREVENTING ESOPHAGEAL DISORDERS

22. 4. Seek treatment for underlying conditions: If you have a condition such
as liver disease or a connective tissue disorder that increases the risk of
esophageal varices or other esophageal issues, it's important to work
with your healthcare provider to manage these conditions and prevent
complications.
5. Practice safe swallowing: Be mindful when eating and drinking to
avoid ingesting items that could potentially damage the esophagus, such
as sharp objects or excessively hot foods and liquids.
6. Regular medical check-ups: If you have a family history of esophageal
disorders or are at higher risk due to other factors, it's important to have
regular check-ups with your healthcare provider to monitor your
esophageal health and catch any potential issues early.By taking these
preventive measures and seeking medical care for any concerning
symptoms, you can help reduce the risk of esophageal disorders and
their potential bizarre effects on the body.

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