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The oesophagus

The oesophagus . Evaluation of oesophageal disorder Symptoms: Heartburn Dysphagia Odynophagia Aghagia Non cardiac chest pain Upper GIT bleeding Weight loss Regurgitation. Dysphagia . Causes of dysphagia in general:- Oropharyngeal dysphagia Oesophageal dysphagia

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The oesophagus

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  1. The oesophagus Evaluation of oesophageal disorder Symptoms: Heartburn Dysphagia Odynophagia Aghagia Non cardiac chest pain Upper GIT bleeding Weight loss Regurgitation

  2. Dysphagia • Causes of dysphagia in general:- • Oropharyngeal dysphagia • Oesophageal dysphagia • Oesophagitis---reflux oesophagitis ---infection ---peptic ---erosive

  3. Causes of oropharyngeal dysphagia • Congenital or acquired • Intrinsic or extrinsic causes • A. Neurological disorder • B. Neuromuscular disorder • C. Muscular disorder • D. Motility disorder • E. Structural defect

  4. Causes of oesophageal dysphagia Mechanical obstruction—solid food worse than liquids ---schatzki ring__intermittent dysphagia not progressive ---peptic stricture__chronic heart burn ,progressive dysphagia ---oesophageal CA__progressive ;age over 50 years

  5. 2. Motility disorder Achalasia__progressive Diffuse oesophageal spasm__imtermittent;not progressive;may have chest pain. Scleroderma__chronic heart burn;rhynaud phenomenon. Other causes:- Chronic alchoholism DM Extrinsic compression(mediastinal tumor) Psychological.ex:-globus hystericus

  6. Other symptoms • Odynophagia • Regurgitation • Weight loss • Upper GIT bleeding

  7. Gastro esophageal reflux disease • Normal defensive mechanism of reflux • Incidence 20% weekly exposure 7-10%daily exposure 30% of general population

  8. Causes and predisposing factors • External influence---smoking, NSAID ---eating fat&chocolate coffee&tea ---large meal ---alcohol ---drug,hyosin group ,bronchodilator ,antianginal drugs ,antipsychotic drugs

  9. Defective oesophageal clearance • Sleep • CREST syndrome • Impaired salivation • Hiatus hernia

  10. Abnormal lower osephageal sphincter • Mild symptomes10-30 mmHg • Severe symptomes less than 10 mmHg Causes:-drug effect -post surgical treatment for achalasia -stent tube for CA

  11. Delay gastric emptying • Causes Gastro paresis—DM __alcoholism __old age __drug effect Partial gastric outlet obstruction Hormonal effect menstruation and pregnancy .

  12. Increase intra abdominal pressure • Obesity • Pregnancy • Cosmetic instrument

  13. Clinical features • Heart burn, regurgitation:- High degree of reliability of symptoms Dyspepsia Sensitivity 78% Specificity 68% Severity=symptoms=endoscopy Dysphagia ---abnormal peristalsis ---complications as stricture or CA Increase menifestations of other diseases like BA Ch. Cough,ch. Laryngitis, sore throat ,atypical chest pain

  14. investigations • 1. no investigations • 2. exclusion of hard signs dysphagia weight loss anemia (IDA) age more than 50 years cervical LAP poor response to therapy • Endoscope is Ix of choose • Ambulatory oesophageal Ph monitoring ,the best document of acidity and reflux. • Oesophageal manometer

  15. complications • Oesophagitis • Barrett’s oesophagus • Anemia • Benign oesophageal stricture • Malignant transformation

  16. management • General measures loss of weight raise head no smoking no alcohol time interval no prebed meal no fatty meal at night Medical measure simple heart burn mild symptoms and persistent symptoms severe case

  17. oesophagitis Infectious oesophagitis Pill induced oesophagitis Corrosive oesophagitis

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