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3. Diseases of the oesophagus: Difference between revisions
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(Created page with "''Written by ms. Worldwide, edited by Nikolas'' This topic covers these pathologies that can occur with the esophagus: * Congenital malformations * Functional disorders * Vascular diseases * Inflammations * Neoplasms Focus on the neoplasms. Now let’s get started! == Congenital malformations == === '''Atresia and fistulas''' === This happens when the congenital segmental closure of oesophagus fails for some reason. This often ends up with fistulas which connect the...") |
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== Congenital malformations == | == Congenital malformations == | ||
=== | === Atresia and fistulas === | ||
This happens when the congenital segmental closure of oesophagus fails for some reason. This often ends up with fistulas which connect the upper or lower pouches of oesophagus to the trachea or even to the bronchus. | This happens when the congenital segmental closure of oesophagus fails for some reason. This often ends up with fistulas which connect the upper or lower pouches of oesophagus to the trachea or even to the bronchus. | ||
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== Functional disorders == | == Functional disorders == | ||
=== | === Achalasia === | ||
Achalasia is a rare disorder of oesophageal motility. It's characterised by inadequate relaxation of the lower oesophageal sphincter (LES) tone due to the degeneration of inhibitory neurons. Food can’t pass through to the stomach normally which results in dilation of the oesophagus, which may lead to more severe complications like perforation. | Achalasia is a rare disorder of oesophageal motility. It's characterised by inadequate relaxation of the lower oesophageal sphincter (LES) tone due to the degeneration of inhibitory neurons. Food can’t pass through to the stomach normally which results in dilation of the oesophagus, which may lead to more severe complications like perforation. | ||
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In NERD, which accounts for 60% of cases, the gastroesophageal mucosa is visibly normal. In ERD, erosions are present on the mucosa. Complicated ERD is characterised by the presence of complications like ulcers, stenosis, or Barrett oesophagus. | In NERD, which accounts for 60% of cases, the gastroesophageal mucosa is visibly normal. In ERD, erosions are present on the mucosa. Complicated ERD is characterised by the presence of complications like ulcers, stenosis, or Barrett oesophagus. | ||
=== | === Hiatal hernia === | ||
In hiatal hernia a portion of the stomach will herniate through the hiatus in the diaphragm that the oesophagus goes through, the oesophageal hiatus. This is a result of increased abdominal pressure and a lax oesophageal hiatus. | In hiatal hernia a portion of the stomach will herniate through the hiatus in the diaphragm that the oesophagus goes through, the oesophageal hiatus. This is a result of increased abdominal pressure and a lax oesophageal hiatus. | ||
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Sliding hiatal hernia is often treated conservatively, while paraoesophageal hiatal hernia is often treated surgically. | Sliding hiatal hernia is often treated conservatively, while paraoesophageal hiatal hernia is often treated surgically. | ||
== | == Diverticular diseases == | ||
A diverticulum is a circumscribed outpouching of the wall of a hollow organ. Oesophageal diverticula may be true diverticula, where all layers of the wall are pouched out, or pseudodiverticula, where the mucosa and submucosa herniate through a weakness in the muscularis propria. | A diverticulum is a circumscribed outpouching of the wall of a hollow organ. Oesophageal diverticula may be true diverticula, where all layers of the wall are pouched out, or pseudodiverticula, where the mucosa and submucosa herniate through a weakness in the muscularis propria. | ||
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Let’s look at the different types: | Let’s look at the different types: | ||
Zenker’s diverticulum is a pseudodiverticulum and is found above the upper oesophageal sphincter. It’s the most common type. The outpouching always protrudes posteriorly and can lead to mediastinitis if the diverticulum gets inflamed (diverticulitis). | |||
It’s also a ''pulsion diverticulum'', meaning that it can be caused by increased intraluminal pressure due to inadequate relaxation of the oesophageal sphincter (e.g. caused by achalasia or spastic motility). | It’s also a ''pulsion diverticulum'', meaning that it can be caused by increased intraluminal pressure due to inadequate relaxation of the oesophageal sphincter (e.g. caused by achalasia or spastic motility). | ||
Traction diverticulum | |||
This type is formed by the pulling force of the contracting adhesion bands. It’s a true diverticulum which is associated with tuberculosis or mediastinal lymphadenitis, where scarring happens. | This type is formed by the pulling force of the contracting adhesion bands. It’s a true diverticulum which is associated with tuberculosis or mediastinal lymphadenitis, where scarring happens. | ||
Epiphrenic diverticulum | |||
This is also a pulsion diverticulum, meaning it’s a pseudodiverticulum. It is located in the distal most part of oesophagus and is a result of dysfunctions of the lower oesophageal sphincter, like in achalasia. | This is also a pulsion diverticulum, meaning it’s a pseudodiverticulum. It is located in the distal most part of oesophagus and is a result of dysfunctions of the lower oesophageal sphincter, like in achalasia. | ||
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Oesophageal bleedings can actually be a medical emergency. Let’s look at the different types and find out why. | Oesophageal bleedings can actually be a medical emergency. Let’s look at the different types and find out why. | ||
=== | === Oesophageal varices === | ||
Varices are big vessels formed due to portocaval shunts in patients with portal hypertension. They are usually found in the lower third of the oesophagus and can rupture and cause massive bleedings. This typically occurs in alcoholics, due to alcoholic liver cirrhosis. | Varices are big vessels formed due to portocaval shunts in patients with portal hypertension. They are usually found in the lower third of the oesophagus and can rupture and cause massive bleedings. This typically occurs in alcoholics, due to alcoholic liver cirrhosis. | ||
=== | === Mallory-Weiss syndrome === | ||
Mallory-Weiss syndrome refers to severe upper gastrointestinal bleeding caused by longitudinal tears of the oesophageal mucous membrane. This occurs due to high intraluminal pressure, usually due to severe vomiting. | Mallory-Weiss syndrome refers to severe upper gastrointestinal bleeding caused by longitudinal tears of the oesophageal mucous membrane. This occurs due to high intraluminal pressure, usually due to severe vomiting. | ||
=== | === Boerhaave syndrome === | ||
Boerhaave syndrome refers to oesophageal rupture due to severe vomiting. This causes severe pain and mediastinal emphysema. It’s an emergency condition and is deadly without surgical intervention. | Boerhaave syndrome refers to oesophageal rupture due to severe vomiting. This causes severe pain and mediastinal emphysema. It’s an emergency condition and is deadly without surgical intervention. | ||
== Inflammations == | == Inflammations == | ||
=== | === Reflux oesophagitis === | ||
This is the most frequent cause of esophagitis and is caused by chronic gastroesophageal reflux disease. Reflux of acidic gastric contents into the lower oesophagus, like gastric acid and food, causes chemical irritation. The oesophageal mucosa is vulnerable to acid as it was never intended to be exposed to it. | This is the most frequent cause of esophagitis and is caused by chronic gastroesophageal reflux disease. Reflux of acidic gastric contents into the lower oesophagus, like gastric acid and food, causes chemical irritation. The oesophageal mucosa is vulnerable to acid as it was never intended to be exposed to it. | ||
Risk factors for reflux oesophagitis are the same as for GERD, as well as those risk factors which increase stomach acidity: | Risk factors for reflux oesophagitis are the same as for GERD, as well as those risk factors which increase stomach acidity: | ||
=== | === Infectious oesophagitis === | ||
Infectious oesophagitis is rare but is most frequent in immunosuppressed patients. | Infectious oesophagitis is rare but is most frequent in immunosuppressed patients. | ||
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* Cytomegalovirus oesophagitis – Shallow ulcers and the characteristic Owl-eye appearance can be seen in histology. | * Cytomegalovirus oesophagitis – Shallow ulcers and the characteristic Owl-eye appearance can be seen in histology. | ||
=== | === Eosinophilic oesophagitis === | ||
This is actually a pretty recent disease, and is recognized in more and more people. It involves a pronounced eosinophilic infiltration in the oesophagus. Food or other allergens, like pollen, sensitize the patient and leads to Th2-activation. A genetic predisposition is a cause for this as well. | This is actually a pretty recent disease, and is recognized in more and more people. It involves a pronounced eosinophilic infiltration in the oesophagus. Food or other allergens, like pollen, sensitize the patient and leads to Th2-activation. A genetic predisposition is a cause for this as well. | ||
== | == Preneoplastic lesions – Barrett oesophagus == | ||
Barrett oesophagus is a consequence of chronic GERD where the chronic acid exposure of the oesophageal mucosa causes intestinal metaplasia (Barrett metaplasia). On histology goblet cells can be seen in the mucosa. It occurs in up to 15% of patients with GERD. | Barrett oesophagus is a consequence of chronic GERD where the chronic acid exposure of the oesophageal mucosa causes intestinal metaplasia (Barrett metaplasia). On histology goblet cells can be seen in the mucosa. It occurs in up to 15% of patients with GERD. | ||
Barrett oesophagus is a precancerous lesion which must be treated or at the very least frequently monitored. It may progress into adenocarcinoma. | Barrett oesophagus is a precancerous lesion which must be treated or at the very least frequently monitored. It may progress into adenocarcinoma. | ||
== | == Oesophageal cancer == | ||
=== Introduction and epidemiology === | === Introduction and epidemiology === | ||