Cancer OesophagusSmoking, alcohol intake, obesity and GERD are common esophagus cancer risk factor. Smoking and alcohol cause squamous cell carcinoma. Obesity and acid reflux are risk factors for adenocarcinoma. Healthy life style can prevent esophagus carcinoma The most common symptom is dysphagia. Initially it is for solid food and gradually to liquid also. Patient can have chest pain/regurgitation. Anorexia and weight loss are common. Advance carcinoma patients can have bony pain, abdomen distension due to ascites, respiratory distress due to pulmonary effusion. Esophageal Cancer Diagnosis Upper GI Endoscopy is done by gastroenterologist and is the investigation of choice. It will show growth or stricture in the esophagus. Biopsy will confirm the diagnosis. Most common type of esophagus carcinoma is adenocarcinoma located in the lower third of esophagus. Squamous cell carcinoma is other type and mainly found in the upper and middle third of esophagus Investigations CECT Chest and upper abdomen is done.CECT will show the growth in the esophagus, its relation with surrounding structures, any associated lymph nodes, and metastases. It helps in planning of Esophagus Carcinoma Treatment Treatment The recommended first line Esophagus Cancer Treatment is surgery if cancer is resectable. For locally advance tumor pre-operative chemotherapy is given.If patient respond to chemotherapy and tumor become resectable surgery is done. For metastatic disease endoscopic esophageal stent is placed for relief of dysphagia. If endoscopic stenting is not possible feeding jejunostomy is done surgically for nutrition
GERDGastroesophageal reflux disease (GERD) as the name indicates is the reflux of stomach contents back into the esophagus. Generally what happens, when we ingest food it passes through the esophagus, there is a valve at the lower end of esophagus which relax or opens and food enter into the stomach and after that valve gets closed. When this valve is not competent enough stomach contents reflux back. GERD Causes Improper function of lower esophageal sphincter muscle as described above is the reason for gastroesophageal reflux Symptoms of GERD Heartburn (Burning sensation in chest, usually after eating, worsened at night) Regurgitation of food contents Difficulty swallowing Chronic cough/ New or worsening asthma Risk Factors for GERD: Obesity, Hiatus Hernia, Delayed stomach emptying, Pregnancy Smoking, Alcohol/ Coffee, Eating large meal Complications: Esophagus ulcer is the first finding on endoscopy in simple reflux disease. Long standing reflux can cause Barretts esophagus which is a premaligant condition which predispose to esophagus cancer. Continuous reflux can cause benign esophageal stricture GERD Diagnosis Esophageal pH monitoring is the gold standard test to confirm the prsence of reflux Upper GI Endoscopy Esophageal Manometry Treatment First step is life-style modification Medical treatment include proton pump inhibitors which decrease the amount of acid produced by the stomach. these includes pantocid, rabeprazole. Another group of medicines which are beneficial include H2 blockers, Antacids, Prokinetics Surgical management: Surgery is indicated if above methods fail, and lower esophageal sphincter muscle is weak, associated hiatus hernia. In these cases Niissen fundoplication is done
Diaphragam is a muscular wall which separates chest cavity from abdomen cavity. Hiatus is an opening in the diaphragam through which esophagus enters from thorax into the abdomen. A hiatus hernia occur when stomach most commonly or other abdomen organs enters into thorax through this opening Types of Hiatus Hernia There are two types of hiatus hernia one is sliding and other is paraesophageal. In sliding hernia GE junction migrates into the thorax.In Paraesophageal hernia GE junction remains stable, stomach most commonly or other abdomen organs rolls into the thorax through side of esophagus Symptoms of Hiatus Hernia Most commonly patient present with long history of heartburn. Heartburn is defined as pressure sensation localized to epigastric and retrosternal area which does not radiate to back.As the disease become more severe patient complain of regurgitation of digested food. Dysphagia occur due to mechanical obstruction to food Diagnosis of Hiatus Hernia Upper GI Endoscopy is first step to rule out other disorders whose symptoms mimics with hiatus hernia. It also grades the esophagus injury severity due to acid reflux Medical Treatment of Hiatus Hernia Proton pump inhibitors and life style modification are first step in management of hiatus hernia Surgical Management of Hiatus Hernia Failed medical therapy, Large hiatus defect, Herniation of other abdomen organs are indications for surgery. The standard surgical procedure is reduction of hernia contents with repair of hiatus and fundoplication. It is done Laparoscopically
It is a surgical condition of the esophagus which causes impaired relaxation of lower esophageal sphincter muscle in response to swallowing. Patient complain of difficulty in swallowing and regurgitation. Upper GI endoscopy & manometery are diagnostic . Surgical procedure is Laparoscopic Hellers Myotomy.