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Esophageal Dysphagia and Obstruction - Coggle Diagram
Esophageal Dysphagia and Obstruction
Peptic Strictures
Etiology:
Complication of GERD (Gerd -> Inflammation -> Collagen deposition -> Fibrosis)
Location
Lower Esophagus
Appearance
Smooth, narrow, circumferentail, tapered luminal narrowing
Presentation
Progresive, heart burn without weight loss, food bolus impaction
Treatment
PPI, Progresive Dilation
Esophageal Rings
A Ring
Appearance
Symmetric, hypertrophied muscle covered wtihi squmous epithelium
Presentation
Rare Typically asymptomatic, and rarely dysphagia with colids/liquids
Location
Proximal LES
Treatment
If asymptomatic, no treatment. Symptomatic: Bougie Dilation, Botox injection
B Ring (Schatzki's)
Appearance
Thickened mucosa/squamous (upper portion squamous, lower columnar epithelium)
Presentation
Intermittent, solid food dysphagia, Food bolus impaction, Common
Location
SCJ; usually associated with hiatus hernia, and related to GERD
Treatment
Asymtomatic: None, Symptomatic: Bougie dilation, disruption with biopsy forceps, PPI
Esophageal Webs
Appearance
Thin, horizontal membranes covered by squamous epithelium, asymmetrical
Location
Upper-mid esophagus
Presentation
Asymptomatic, Dysphagia to solids, Associations: Plummer-Vinson symdrome (dyspagia, esophageal webs, IDA)
Treatment
Dilation
Eosinophillic Esophagitis
Etiology
Chronic immune/antigen mediated inflammatory disorder of esophagus, results in abnomral contraction and stricture formation
Pathophysiology
Likely allergic condition - acid dilates intracellular spaces to allow antigen exposure which leads to inflammation and fibrosis
Presentation
Young, intermittend solid food dysphagia, chest pain, and co-existing allergic conditions
EGD
Treatment
PPI Trial/Topical Corticosteroids, Dietary elimination, esophageal dilatation
Achalasia
Pathophysiology
Loss of inhibitory ganglions of myenteric plexus
Etiolgoy
Lack of peristalsis of esophageal body and inability for LES to relax
Symptoms
Dysphagia to solids, liquids, regurgitating bland undigested food and saliva, substernal chest pain during meals
Investigations:
EGD, Barium Swallow, Manometry
Treatment
Pharmacologic (CCB, nitrates, PDI), Endoscopy (Dilatation, Botox injectionn for relaxation), Myotomy
Hypercontractile DIsorders
Distal Esophageal Spasm
Etiology
Caused by either impaired deglutitive inhibition or excessive excitation
Abnormal contractions in mid-distal esophagus
Jackhammer Esophagus
Etiology
Preserved peristalsis but increased contractile pressure and repetitive contractions
Management
Pharmacologic Therapy (CCB, nitrates), Endoscopy (Botox injected above LES), Mytomy (POEM in refractory cases of DES and Jackhammer)
Hypomotility
Scleroderma Esophagus
Etiology
Absent peristalsis and hypotensive LES
Pathogenesis
Vasculopathy, neuropathy, myopathy (collagen deposition, smooth muscle atrophy, firbosis)
Symptoms
Dysphagia, Heartburn
Treatment
PPI, Gerd Lifestyle, Dilation
Foreign Body Ingestion
Most commonly - Food bolus impactions
Complications
Perforation, Obstruction, Bleeding, Respiratory compromise, Fistula formation, Abscess
Symptoms
Dysphagia, odynophagia, Chest pain, choking, sialorrhea, vomiting, respiratory compromise
Treatment
EGD or Surgery when unsuccessful
