Esophageal Conditions

Elobu Emmanuel
MD, Mmed(Surgery), FCS-ECSA
Outline

 Anatomy
 Physiology
 Esophageal Atresia
 GERD
 Esophagitis
 Achalasia
Anatomy
physiology

 Transfer swallowed food from mouth to stomach

 Lubrication
 digestion?
Esophageal Atresia
Embroyology
At 3 weeks proximal and distal gut
Proximal gut forms gastric and
esophageal buds
Followed by separation of tracheal
primordium form esophogus
pathophysiology
Etiology not well understood
Failure of apposition of anterior
longitudinal ridges of esophagus leads
to esophageal fistula
Far Posterior apposition leads to
agenesis/atresia
 Types
CF’s

 Prenatal
 Polyhydromnios
 Absent fetal gastric air bubble
 Other defects in 50% of cases- VACTERAL, CHARGE
 Post natal
 Respiratory distress, cyanotic spells
 Frothing at the mouth
 Recurrent pneumonia
 Failure to fee/thrive
 Failure to pass NGT
diagnosis

 Failure to pass NGT

 X-ray (babygram)
 Caution on use of contrast
 Investigate other abnormalities/ defects appropriately
Management

 Urgent Elective case (not surgical emergency)

 Patient is stabilized and operated within 24 hours of dx
 Resection and anastomosis
 Division of fistula
 Esophagostomy and feeding gastrostomy
 Treat chest infections and
Prognosis
- Poor without surgery
- High post op morbidity and mortality
GERD

 GER = Involuntary return of gastric contents into the esophagus with noxious
stimuli
 Called disease when there are complications
 Maybe physiological upto 3/12
pathophysiology

 Short intrabdmonial esophagus

 Upto 3/12 to reach 3-4 cm
 85% of people with <1cm get GER
 Increased intrabdominal pressure e.g. obesity, pregnancy
 Hiatus hernia
 Delayed gastric emptying, gastroparesis e.g.DM or drugs
 Smoking
 Alcohol Consumption
 Stress
Clinical Features

 Infants and Children

 Effortless non bilious vomiting
 FTT
 Aspiration, chest infections

 Adults
 Heart burn
 Odynopahgia
 Aspiration and chest infections
 Sore throat and hoarse voice
Diagnosis

 24 hour pH monitoring
 Positive if pH less than 4 for 1tleast 1 hour
 Barium Swallow
 Flouroscopy shows reflux
 EGD
 Assess for complications
Management

 Watchful waiting till 3/12

 Thickening of food e.g. with cereals
 Postural Management
 Modification of feeding regimen
 Small frequent meals
 Avoid meals just before bed time
 Prokinetics e.g. emetochlopramide, domperidone, erythromycin
 Anti-acids- PPI, anti-H2
Management Cont’d

 Surgical Rx
 Gastric fundoplication

 Address risk factors

Complications

 Esophagitis
 Stricturing
 Barrets esophagus
 Malignant transformation
Esophagitis

 Inflammation of the mucosa of esophagus

causes

 GER
 Corrosives
 Infections
 Candida
 TB
 Foreign Body
 Drugs
 Vitamin C, tetracycline, aspirin
Presentation

 Odynophagia
 Dysphagia
 Hematemesis
 Melena
 Chest pain
Diagnosis

 EGD
 bx
complications

 Stricture
 Barrett's esophagus
 Malignant transformation
 Nutritional Challenges
Management

 Depends on cause
 Treat infection
 Anti-acid therapy, steroid therapy
 Dilatation
 Stenting
 Esophageal replacement
 Feeding gastrostomy +/- esophagostomy
achalasia

 Neurologic disease
 Failure of peristalsis in proximal esophagus leading to failure of relaxation of the
gastroesophageal sphincter
Clinical features

 Dysphagia
 Liquids →→ solids
 Vomiting –
 Chewed / partially digested
 Copious Foul smelling non bilious
 Aspiration → chest infections
 FTT/ malnutrition in childres
Diagnosis

 Barium Swallow
 Narrow smooth stricture
 Holding up of barium
 Dilated proximal esophagus
 Compare with CA esophagus
Management

 Non surgical
 Chemical sphicterotomy
 Botulinim toxin
 Calcium channel blockers

 Dilatation
 Surgery
 Hellers’s cardiomyotomy