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Esophageal Conditions Overview

Hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the chest. There are two main types - sliding and paraesophageal. Complications include gastric volvulus and perforation. Treatment involves medication, lifestyle changes, or surgery such as fundoplication. Barrett's esophagus involves replacement of the esophageal lining with abnormal columnar cells and increases cancer risk. Esophageal tumors can be benign such as leiomyomas or malignant like squamous cell carcinoma and adenocarcinoma. Treatment depends on tumor type and stage but may involve surgery, radiation, chemotherapy, or stenting.

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Ali Abbas
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4K views45 pages

Esophageal Conditions Overview

Hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the chest. There are two main types - sliding and paraesophageal. Complications include gastric volvulus and perforation. Treatment involves medication, lifestyle changes, or surgery such as fundoplication. Barrett's esophagus involves replacement of the esophageal lining with abnormal columnar cells and increases cancer risk. Esophageal tumors can be benign such as leiomyomas or malignant like squamous cell carcinoma and adenocarcinoma. Treatment depends on tumor type and stage but may involve surgery, radiation, chemotherapy, or stenting.

Uploaded by

Ali Abbas
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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HIATAL HERNIA

 Separation of the diaphragmatic crura and


widening of the space between the
muscular crura and the esophageal wall.
 This leads to portion of stomach entering
into thorax..
TYPES
 Sliding hernia :
Gastroesophageal junction and fundus of
stomach slide upward.

 Paraesophageal hernia :
Gastroesophgeal junction is fixed but part
of the stomach herniates into the chest.
Normal GE junction
Sliding hiatal hernia
Paraesophageal hernia
 Complications
- Gastric volvulus
- strangulation
- perforation
 Investigations
- Plain X – ray chest & abdomen
- Barium swallow study
- Endoscopy
 Treatment
- Medical
- Head end elevation
- Abstain from alcohol, smoking
- Antacids, PPI’s

- Surgery
- Reduction of hernial contents
- Nissen’s fundoplication
DIVERTICULA
 A diverticulum is an out pouching of the
alimentary canal that contains all the
layers.
 Types – true and pseudo
 Pseudo diverticulum only mucosa and
sub mucosa.
According to site
 Zenker diverticulum - pharyngoesophageal
 Traction diverticulum - midpoint of
esophagus because of inflammation
 Epiphrenic diverticulum – immediately
above LES.
symptoms
 Asymptomatic
 Dysphagia
 Food regurgitation
 Mass in the neck
 Halitosis
 Aspiration
Management
 Barium swallow study
 Endoscopy
 Diverticulectomy
Lacerations
 Mallory-weiss syndrome
 Boerhaave’s syndrome
BARRETT’s ESOPHAGUS
 The distal squamous mucosa is replaced
by metaplastic columnar epithelium as a
response to prolonged injury.
 Single most important risk factor for
esophageal adenocarcinoma.
 Occurs as a complication of long standing
GERD.
Types
 Long segment - involving > 3 cms
 Short segment – involving < 3 cms.
Criteria
 Endoscopic evidence – Indocarmine spray
 Histological evidence – multiple biopsies
Barrett’s esophagus
Pathogenesis
 Chronic irritation leads to change in the
differentiation program of stem cells of the
esophagus mucosa.
Clinical features
 Age – 40 to 60 yrs
 More common in white males.
 Symptoms of reflux esophagitis.
 Complications
Bleeding, Ulceration, Stricture and
development of Adenocarcinoma.
 Hence reflux esophagitis should be treated
aggressively with drugs and if needed
surgery to prevent Barretts’s esophagus
 Endoscopic surveillance should be done in
patients with Barrett’s esophagus
 Once high grade dysplasia is detected
treatment of choice is esophagectomy of
the segment
 Photodynamic laser, thermo-coagulative
mucosal ablation, and endoscopic
mucosal resection are being evaluated as
alternatives
TUMOURS
 Benign
Leiomyoma, fibroma, lipoma,
neurofibroma

 Maliganant
SCC, Adeno Ca, Carcinoid, Melanoma,
lymphoma.
Benign tumors
 The most common is leiomyoma
 Fibroma, neurofibroma, lipoma,
hemangioma may also arise.
 Polyps
 Inflammatory pseudotumor
Leiomyoma esophagus
Malignant
 Constitutes about 6% of GI malignancies.
 Majority are epithelial.
 Globally SCC is the commonest
esophageal carcinoma.
 In US the incidence is almost same for
SCC and Adenocarcinoma.
Squamous Cell Ca
 Most common type of carcinoma esophagus.
 Age – over 50 years.
 Incidence varies with country.
 Blacks are at more risk compared to whites.
 Seen in Upper & middle 1/3rd
 Constitutes about 40% of esophageal ca.
Adenocarcinoma
 The majority arises from barrett mucosa.
 Tobacco, obesity are the risk factor
 Usually located in lower end of esophagus
 In contrast to SCC whites are more
affected than blacks.
 5 year survival rate is under 20%.
 Incidence is about 45%
Staging - TNM classification
T – Tumour size
N - Nodal involvement
M - Metastasis

Grading – Histopathological
- Well differentiated
- Moderately differentiated
- Poorly differentiated
 Three morphological pattern
- Exophytic
- Flat
- Ulcerative.
 Most are moderate to well differentiated.
AETIOLOGICAL FACTORS for SCC
 Smoking
 Alcohol excess
 Chewing betel nuts or tobacco
 Coeliac disease
 Achalasia of the oesophagus
 Post-cricoid web
 Post-caustic stricture
 Tylosis (familial hyperkeratosis of palms and
soles)
 Aetiological factors
- Chronic GERD
- Barrett’s esophagus
- Tobacco & alcohol consumption
Clinical presentation

 Progressive dysphagia to first for solid


food then for liquids
 Weight loss
 Halitosis
 Regurgitation
 Hoarseness
 Hypercalcemia
Investigations

 Barium swallow
 Endoscopic biopsy
 Endo ultrasonography with tissue biopsy
 CT scan
 MRI
Ba swallow – Ca esophagus
Ca Esophagus
Ca Esophagus
Treatment
 Surgery remains the main stay with proper
clearance margin
 Local and distant recurrence is common.
 Five year survival rate is 75%.
 Surgery
- Esophagectomy with surrounding lymph
node excision

 Radiotherapy
- SCC more radiosensitive
- AdenoCa radioresistant
 Chemotherapy
- 5 FU
- Cisplatinum

 Palliative
- Metallic stenting
- Laser ablation

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