Professional Documents
Culture Documents
WHAT ABOUT?
Simptoms and signs
Investigations
Gastroesophageal Reflux
Esophagitis
Esophageal Cancer
Motility Disorders: Achalasia and D. Spasm
Structural Anomalies and Miscellaneous
Disorders of the Esophagus
Simptoms and signs
1. DYSPHAGIA
Sensation of food being hindered in its
passage from mouth to stomach
Oropharyngeal - odynophagia
Esophageal dysphagia
Simptoms and signs
DYSPHAGIA
Oropharyngeal - (odynophagia-pain at swallowing)
– Neuromuscular disease (Cerebrovascular accident, Parkinson,
Wilson, Brain stem tumors, polymyositis, amyloidosis,
systemic lupus erytematus)
– Local mechanical lesions: inflammation (pharyngitis),
tumours, Zenker diverticulum
Esophageal dysphagia
– Motility disorders (achalasia, scleroderma, diffuse spasm,
nutcracher esophagus)
– Intrinsic mecanical lesions (benign stricture, carcinoma,
foreign bodie, esophageal diverticulum, Schatzki ring)
– Extrinsic mechanical lesions (mediastinal abnormalities-
pulmonary carcinoma, adenopaty, pericarditis, mitral stenosis,
cervical osteoarthrities)
Simptoms and signs
DYSPHAGIA
Onset ( acute, chronic);
Total or partial;
paradoxical (achalasia).
2. HEARTBURN (PIROSIS)
(most tipical symptom for GE Reflux D)
3. PAIN: Anterior toracic pain (motility
disorders, cancer)
TYPICAL
– Heartburn
– regurgitations
– esophageal pain
– dysphagia
ATYPICAL (respiratory, laryngitis, dental)
When to Perform Diagnostic Tests
Uncertain diagnosis
Atypical symptoms
Symptoms associated with complications
Inadequate response to therapy
Recurrent symptoms
Prior to anti-reflux surgery
INVESTIGATIONS
Esophageal 24 H pH-metry
Esophageal Manometry
Esophageal impedance
ENDOSCOPY
ESOPHAGITIS/ NO ESOPHAGITIS
COMPLICATIONS BARRETT
ESOPHAGUS
ENDOSCOPY
ENDOSCOPY
ENDOSCOPY
ENDOSCOPY
Barium Swallow
Gastroesophageal X-Ray
Trendelenburg position
Hiatal Hernia
Stenosis
PH- metry
Wireless, Catheter-Free Esophageal pH Monitoring
Potential Advantages
• Improved patient
comfort and acceptance
• Continued normal work,
activities and diet study
• Longer reporting periods
possible (48 hours)
• Maintain constant probe
position relative to SCJ
Esophageal Manometry
No Reflux Reflux
15 cm
6 impedance channels
2 pH channels
9 cm
7 cm
5 cm pH - 5 cm
3 cm
pH at tip
Adult with Gastric pH
Model ZAN-S62C01E
COMPICATIONS
Esophageal stricture
BENIGN ESOPHAGEAL STENOSIS
ENDOSCOPY
COMPLICATIONS
Barrett's esophagus
Esophageal Cancer
Adenocarcinoma
X-Ray
Ecoendoscopy
Eso-bronchial fistula
Motility disorders
Achalasia
Difuse spasm
ACHALASIA
Def. Motility disorder characterized by increased
lower esophageal sphincter pressure and failure to
relax during swalowing. Peristalsis of body is
absent
Et: degeneration of myenteric plexus of unknown
cause
Achalasia- clinical features-
Occours at any age
Dysphagia -all patients;slowly progressive
+paradoxical dysphagia
Weight loss- quite common
Regurgitations - 30%; undigested food with
aspirations
pain- substernal cramps may be severe and
precede dysphagia
INVESTIGATIONS
Radiology:
INVESTIGATIONS
Esophageal manometry:
– absence of LOS relaxation with swallowing
– hipertensieve LOS
– absence of peristaltic contractions
Manometric LES tracing of pull through in patient with achalasia
Manometric tracing of a patient with achalasia
Manometric tracing of a patient with achalasia
INVESTIGATIONS
Endoscopy:
– dilated esophagus with
food debrie
– endoscope is passing
easily in the stomach
TREATMENT
Motility disorders
Achalasia
Difuse spasm