(From Robbins and lecture, 12-16 Feb 2001, by Brian Buschman)
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Dysphagia is difficulty in swallowing.
Atresias and fistulas present a big problem with regards to aspiration. Atresias are most common towards the area that is shared by the bronchi.
Congenital stenosis may exist but stenosis is MN in adults as a result of trauma. Fibrosis of the submucosa and hypertrophy of the muscularis. Stenosis of a point is called a ring. At the top the rings are called webs and at the bottom they are called Schatzki’s rings.
The esophagus needs coordinated motor function and four things can result from a loss of coordination:
1) Achalasia or a failure of relaxation leads to dilation of the esophagus. This leads to regurgitation and dysphagia. Achalasia shows aperistalsis, incomplete relaxation of the LES and increased resting tone of the LES.
Achalasia may be from agenesis of the myenteric plexus or a problem like Chagas’ disease (from Trypanosoma cruzi) which destroys the myenteric plexus. These patients have increased risk of esophageal squamous cell carcinoma.
2) Hiatial hernias may be siding hernias where three is a hunk of stomach that slides through the esophageal hiatus. They are common in adults but have few symptoms and often do not present. Surgery, such as to correct a sliding hernia cay cause a paraesophageal hernia. A paraesophageal hernia just has an edge or corner of the stomach that slips through the esophageal hiatus.
3) A diverticula may exist in the esophagus. A pharyngeal diverticulum is often cause by weak pharyngeal muscles and the esophagus just pushes out making the pouch. Distal esophageal diverticuli are called traction diverticuli and result from a fribrosing reaction in the mediastinum.
4) Lacerations (Mallory-Weiss tears if superficial) are often a result of excessive vomiting. They usually heal well with little residua.
With portal hypertension esophageal varicies develop. They are usually asymptomatic until they bleed. With significant bleeding there is a 40% mortality.
Esophagitis may be caused by:
1) Reflux esophagitis (this is the most common cause)
2) Prolonged gastric intubation.
3) Ingestion of irritants (including chemotherapeutic agents)
4) Infection (Herpes, CMV)
5) Uremia
6) Radiation
Gastric reflux is the most common cause of esophagitis and may be triggered/effected by:
1) Decreased antireflux mechanisms.
2) Slowed clearance of refluxed material.
3) Increased gastric volume (the more volume there is the more will be refluxed).
4) Reduced esophageal repair.
Histologically esophagitis will present according to the cause. With infection there will be eosinophilia. With herpes and CMV there will be punch-outs in the tissue. Chemical injury will show necrosis. All cases will develop and show fibrosis.
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