Chapter 038. Dysphagia (Part 4) pot

Dysphagia Part 4 Table 38-2 Esophageal Dysphagia Esophageal Mechanical Dysphagia I.. Lower esophageal mucosal ring Schatzki's ring... Host-versus-graft disease, mucocutaneous disorder

Chapter 038 Dysphagia

(Part 4)

Table 38-2 Esophageal Dysphagia

Esophageal Mechanical Dysphagia

I Wall defects

A Congenital

B Tracheoesophageal fistula

II Intrinsic narrowing

A Inflammatory esophagitis

1 Viral (herpes simplex, varicella-zoster, cytomegalovirus)

2 Bacterial

3 Fungal (Candida)

4 Mucocutaneous bullous diseases

5 Caustic, chemical, thermal injury

6 Eosinophilic esophagitis

B Webs and rings

1 Esophageal (congenital, inflammatory)

2 Lower esophageal mucosal ring (Schatzki's ring)

3 Eosinophilic esophagitis

4 Host-versus-graft disease, mucocutaneous disorders

C Benign strictures

1 Peptic

2 Caustic

3 Pill-induced

4 Inflammatory (Crohn's disease, Candida, mucocutaneous lesions)

5 Ischemic

6 Postoperative

7 Post-radiation

8 Congenital

D Tumors

1 Benign

2 Malignant

III Extrinsic compression

A Vascular compression (dysphagia lusoria, aberrant right subclavian artery, right-sided aorta, left atrial enlargement, aortic aneurysm)

B Posterior mediastinal mass

C Postvagotomy hematoma and fibrosis

Esophageal Motor Dysphagia

I Disorders of cervical esophagus

(see oropharyngeal motor disorders, Table 38-1)

II Disorders of thoracic esophagus

A Diseases of smooth muscle or excitatory nerves

1 Weak muscle contraction or LES tone

a Idiopathic

b Scleroderma and related collagen vascular diseases

c Hollow visceral myopathy

d Myotonic dystrophy

e Metabolic neuromyopathy (amyloid, alcohol?, diabetes?)

f Drugs: anticholinergics, smooth muscle relaxants

2 Enhanced muscle contraction

a Hypertensive peristalsis (nutcracker esophagus)

b Hypertensive LES, hypercontracting LES

B Disorders of inhibitory innervation

1 Diffuse esophageal spasm

2 Achalasia

a Primary

b Secondary (Chagas' disease, carcinoma, lymphoma, neuropathic intestinal pseudo-obstruction syndrome)

3 Contractile (muscular) lower esophageal ring

Note: LES, lower esophageal sphincter.