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Esophageal diseases
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Symptoms of esophageal diseases:

is most 1- Heartburn: It is the most common symptom and

associated with reflux. As can be said with this symptom

He started experimental treatment of reflux.

2- Regurgitation: Returning the contents of the digestive system

into the mouth without effort

3- Chest pain: First, cardiac and emergency causes should be ruled out

and then attributed to the esophagus. The most common cause of

chest pain is reflux.

4- Dysphagia: solid or liquid food is stuck in the esophagus. If only

solids are stuck, there is a mechanical disorder such as stenosis or web

or tumor.
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If both solids and liquids get stuck, movement disorders such as achalasia are considered.

5-Odinophagia: Pain when food passes through the esophagus includes esophagitis such as pill or

infectious esophagitis.

6-Globus sensation: The feeling of a lump in the throat. It is not related to swallowing and sometimes it

even gets better with swallowing. Its causes are anxiety disorders and sometimes reflux.

7- Sour feeling or brash water: The secretion of a large amount of saliva is due to acidification of the

esophageal mucosa. It is usually caused by reflux.

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Methods of diagnosing esophageal diseases:

1-Endoscopy: It is both diagnostic and therapeutic

2- Contrast-enhanced imaging: it can detect hernias, diverticula, strictures. It is not a treatment. It is

more sensitive than endoscopy to detect strictures.

3-EUS: It is used to determine the stage of tumors, evaluate dysplasia, and other mucosal lesions. 4-

Manometry: to diagnose

And esophageal motility disorders like achalasia, it is necessary to examine the upper and lower

esophageal sphincters as well as the movements of the esophageal wall.

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5- Reflux test or pH meter: It is a definite diagnosis test for reflux and when

that we have atypical symptoms or lack of response to treatment, it is done. If more than 5

the esophagus is less than 4, the test is positive. If the day and night pH of

Esophageal diseases

Hiatal hernia: There are 4 types:

And the most common cause is reflux Sliding type or type 1: It is the most common. Only GEJ is

herniated.
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Type 2: Only the fundus is herniated.

Type 3: Both fundus and GEJ are involved.

Type 4: Other viscera other than the stomach (such as the colon) yes, including the mediastinum

They become herniated.

3 risk of volvulus and gastric gangrene Darneld. Dermelan Nelou 1 Dermelan And Types 2

and other types in the salurt of Alamtaldar Bluden Bayld Jarrahli Riqalex is

become
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and webs (webs and Ring): rings

There are several types:

- 1 ring B, which is in 10 to 15 percent of people, and a mucous ring in the lower facet.

require treatment. It is esophagus. Its origin is unknown and it is usually asymptomatic and does not

It has an acquired origin. Esophageal diameter And 2-Shatzky's ring: this is also in the lower part of the esophagus

and is less than 13 mm. The most common cause of intermittent dysphagia is solid foods

It is called Steakhouse syndrome. Treatment in symptomatic types with endoscopy and dilation of the site

It is a loss.

3- Rings in the upper part of the esophagus: if they are symptomatic and accompanied by IDA in middle-aged women

It is called Palmer-Vinson syndrome.

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Esophageal diverticula: its types include the following:

Epiphrenic (in the lower part of the esophagus), Zenker (in the upper part of the esophagus) and traction

(diverticules of the middle part of the esophagus)

Zenker's diverticulum: It is due to cricopharyngeus muscle tightness. It was asymptomatic

If they are big, they cause dysphagia and regurgitation of undigested food.

Epiphrenic diverticulum is usually due to achalasia.

Types of traction are caused by long-term inflammations such as inflammation caused by tuberculosis.
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Esophageal tumors: There are two types:

Adenocarcinoma: They are more common in obese white men and their common location is distal

It is the esophagus. Its cause is usually Barrett's esophagus due to prolonged reflux.

well as consumption SCC: Its causes are smoking and alcohol, ingestion of caustic substances and infection with HPV, as

The tea is hot. They mostly occur in the proximal parts of the esophagus.

Symptoms of esophageal tumors include progressive (not intermittent) dysphagia to solid foods and

weight loss
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Congenital diseases of the esophagus:

1-Lousuria dysphagia is the passage of the ectopic sub-Calvin artery through the back of the esophagus

It causes pressure on the esophagus and causes dysphagia.

2- Ectopic gastric mucosa (Inlet patch) Abnormal presence of gastric mucosa

And It is in the proximal esophagus, which has the ability to produce acid. It is usually asymptomatic

No treatment is required.
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Esophageal motility disorders: including two diseases of achalasia and diffuse esophageal spasm

) is DES ).

Asha Alzai:

It is due to the destruction of the ganglion of the myenteric plexus of the esophagus due to autoimmune causes

And Both excitatory and inhibitory nerves are involved. The result of which is the lack of relaxation of the LES

Absence of esophageal peristalsis waves.

Genetics and infection with HSV 1 are involved in the development of achalasia.

The disease is more common between the ages of 20 and 65.

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Symptoms include progressive dysphagia to solids and liquids, regurgitation, chest pain

Breast and weight loss.

If achalasia starts at an old age or the onset of symptoms is less than 1 year ago

or severe weight loss, false achalasia (tumoral infiltration) should be considered

and if So, in the evaluation of a person with achalasia, endoscopy is an important measure,

In these cases, if endoscopy is normal, CT or EUS should be performed.

And the role of endoscopy in diagnosis only Definitive diagnosis of achalasia is by manometry

In the above cases, it is false to reject Ashalazi.

esophageal SCC.
Achalasia itself is one of the FRs of
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LES and absence of peristalsis. Two criteria for its diagnosis in manometry are lack of relaxation of

In barium swallow esophagus, bird's beak view due to lack of relaxation

The
LES and barium accumulation in the esophagus are dilated.

Treatment improves dysphagia and regurgitation, but chest pain does not respond

It doesn't do any good.

The main treatment for achalasia consists of endoscopic LES dilation or endoscopic myotomy

Is.

Drug treatment includes sildenafil, nitrates, calcium channel blockers, which effect

They don't have much. Another treatment is botulism toxin injection with an endoscope into the LES

It is that its effect is temporary. We do surgery in resistant cases.

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Diffuse esophageal spasm:

It is idiopathic. Symptoms include intermittent attacks of dysphagia and severe chest pain

It is caused by abnormal esophageal contractions with normal LES.

Definite diagnosis is with manometry, in which long and high-amplitude contractions

We will see Mary. In barium, it is the tertiary contractions that cause the corkscrew appearance

or the esophagus has a corkscrew. Other views in the barium swallow include the grain esophagus

It is a rosary and diverticulum, as well as a ringed esophagus.

Treatment includes antidepressants. Nitrates and calcium blockers and botulism effect

They are less. Only in cases of severe unbearable pain and severe weight loss

We do surgery.
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DES in manometry including the absence of peristalsis in achalasia The difference between Asha Alazi and

Is.

Esophageal reflux (GERD):

Its creation mechanisms include 3 items:

1-temporary relaxation of LES -2 reduction of LES pressure -3 anatomical disorder in LES

especially hiatal hernia (SHH)

Complications of reflux include: esophagitis, esophageal stricture, Barrett's esophagus, adenocarcinoma

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Reflux risk factors:

Obesity, pregnancy, increased gastric secretion, delayed gastric emptying, overeating

Typical symptoms include heartburn and regurgitation. Other symptoms are all

They are atypical, such as dysphagia, chest pain, hoarseness, cough

Extraesophageal complications of reflux include asthma, chronic cough, laryngitis and caries

It is a tooth.

contrary to Peptic ulcer, which causes narrowing of the esophagus, is one of the complications of reflux

Ulcers caused by infectious esophagitis are isolated and in the distal esophagus.
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In eosinophilic esophagitis, multiple esophageal rings, large mucosal folds, etc

We see pointy white exudates in esophagitis caused by a single and deep ulcer

It is seen in the place of natural strictures of the esophagus, especially near the carina (proximal esophagus).

can be

In infectious esophagitis, the ulcers are diffuse and in the proximal esophagus.

Mary Barrett:

And in that intestinal cylindrical tissue is the most severe histological complication of reflux

And in the long run, it replaces the squamous mucosa of the esophagus. It is created in the distal esophagus

There is a risk of developing esophageal adenocarcinoma.

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Therefore, during endoscopy, a biopsy should be taken from any suspicious area of Barrett's esophagus.

Treatment of Barrett's esophagus is performed only in case of high grade dysplasia

It involves endoscopic removal of the dysplasia area.

Reflux treatment:

1- Life style modifications: including avoiding causative foods such as fat, alcohol, mint

, coffee and tea and also avoid eating before sleep

Elevating the head of the bed and losing weight are useful in the treatment of reflux.

2- Drug treatment includes acid secretion inhibitors, especially PPIs.

3. In cases of non-response, we perform surgery.

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Eosinophilic esophagitis:

It is known to be associated with reflux. Its cause is sensitization to antigens.

It is more common in people with a history of allergic diseases. Its main symptom is dysphagia

Other symptoms include chest pain and heartburn. Blood eosinophil

The environment is high in 25-50% of patients.

In endoscopy, multiple esophageal rings, longitudinal mucosal folds and point exudate

In the biopsy sample, they have more than 15 eosinophils per HPF, which causes

Proof is recognized.
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sticking, and perforation. Complications of this disease include esophageal stricture, food

The first step is to treat PPI to eradicate reflux

Allergen removal should be done Eosinophilia did not disappear and topical corticosteroids were swallowed

If it still doesn't work, systemic corticosteroid is the next line.

Infectious esophagitis:

candidiasis are the two main causes Its main symptoms are odynophagia and dysphagia. HSV and

They are the ones that occur mostly in immunocompromised people. HIV esophagitis in 4CD

Below 100 is seen more.

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In candidal esophagitis, we see fragile white plaques in endoscopy. treatment

It is oral fluconazole.

2 can be created And Herpetic esophagitis caused by both types of HSV type 1

And in the biopsy Endoscopy is in the form of vesicles or small wounds

And we see giant cells. The treatment is with acyclovir. A type quadri inclusions

CMV esophagitis is more common in grafts. In spiral wound endoscopy

(Serpiginous) in the distal esophagus. In the biopsy, inclusion bodies inside

It is nuclear or cytoplasmic. The treatment is with ciclovir.

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Mallory Weiss Rupture:

As a result of repeated vomiting or coughing, for example, in pregnant women or alcoholics, mucosal tears

It occurs in the GEJ area, which also causes GIB. Previous history of retching and vomiting

require treatment. It is beneficial for GIB. It is usually self-limited and does not

Radiotherapy esophagitis:

It occurs in the treatment of breast and lung cancers with radiotherapy. It causes fibrosis and destruction

becomes tissue and its main complication is the creation of stricture in the esophagus years after the completion of radiotherapy

The treatment of the acute type is conservative and the treatment of the chronic type is dilatation of the stricture with an endoscope.
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Esophagitis caused by caustic substances:

and to a lesser extent acidic substances. The important point is that the absence is caused by alkaline substances

Oral injury does not rule out esophageal injury. Endoscopy must be done. Complications

It is esophageal stricture, bleeding and perforation. Prescribing Corton is useless and should not be done

And it is forbidden to induce vomiting for treatment. Also neutralizing substances

Is.

Esophagitis caused by pills:

It is caused by taking pills without enough liquids. In natural esophageal strictures

It is especially near the carina or aortic arch.

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And iron tablets, potassium chloride, and bisphosphonates are more common in NSIAD use

So Symptoms include sudden chest pain and odynophagia that last for several hours

It is caused by taking pills. In endoscopy, the wound is in the place of natural strictures of the esophagus

We see. Treatment includes giving PPI.

Esophageal foreign body:

It is mostly a bite of food. Sometimes a foreign object causes a complete obstruction of the esophagus and causes

Inability to swallow saliva and severe chest pain

After removal, a biopsy should be performed to rule out underlying pathologies such as stenosis

EOE to be done.
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The treatment of the foreign body is to remove it with an endoscope. Sometimes it can be done before that

Intravenous glucagon was used to facilitate the removal of food, but digestive enzymes

You should not give meat because they cause damage to the esophagus.