ESOPHAGEAL PATHOLOGIES
Achalasia: Failure of relaxation of lower esophageal sphincter due to loss of myenteric plexus (Auerbach). High lower esophageal sphincter opening pressure and uncoordinated peristalsis lead to progressive dysphasia.
“Bird’s beak” on barium swallows.
Dilated esophagus with an area of distal stenosis.
Associated with increase risk of carcinoma.
Secondary Achalasia may arise from Chagas’ disease.
Gastroesphageal reflux disease (GERD): Commonly presents as heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea.
Esophageal varices: Painless bleeding of submucosal veins in lower ⅓ of esophagus.
Mallory-Weiss syndrome: Painful mucosa laceration at the gastroesophageal junction due to severe vomiting. Leads to hematemesis. Usually found in alcoholics and bulimics.
Boerhaave syndrome: Transmural esophageal rupture due to violent retching. “Been-heaving syndrome”.
Esophageal strictures: Associated with lye ingestion and acid reflux.
Esophagitis: Associated with reflux, infection (HSV-1, CMV, Candida), or chemical ingestion.
Plummer-Vinson syndrome (United States Paterson United Kingdom
Triad of:
Dysphasia (due to esophageal web)
Glossitis
Iron deficiency anemia.
Barrett’s esophagus: Glandular metaplasia-replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus. Due to chronic acid reflux (GERD). May becomes adenocarcinoma, results from reflux.
Esophageal cancer: Progressive dysphagea (solid to liquids), weigh loss.
Risk factors: Alcohol/Achalasia
Barrett’s esophagus
Cigarettes
Diverticulitis (Zenker’s diverticulum)
Esophageal webs (Plummer-Vinson Syndrome)
Esophagitis
Familial
Worldwide, squamous cell is most common; in Unite State
Squamous Cell = upper and middle 1/3.
Adenocarcinoma =lower 1/3.
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