Chapter 038. Dysphagia (Part 4)

Table 38-2 Esophageal DysphagiaEsophageal Mechanical DysphagiaI. Wall defectsA. CongenitalB. Tracheoesophageal fistulaII. Intrinsic narrowingA. Inflammatory esophagitis1. Viral (herpes simplex, varicella-zoster, cytomegalovirus)2. Bacterial3. Fungal (Candida)4. Mucocutaneous bullous diseases5. Caustic, chemical, thermal injury6. Eosinophilic esophagitisB. Webs and rings1. Esophageal (congenital, inflammatory)2. Lower esophageal mucosal ring (Schatzkis ring)3. Eosinophilic esophagitis4. Host-versus-graft disease, mucocutaneous disordersC. Benign strictures1. Peptic2. Caustic3. Pill-induced4. Inflammatory (Crohns disease, Candida, mucocutaneous lesions)5. Ischemic6. Postoperative7. Post-radiation8. CongenitalD. Tumors1. Benign2. Malignant ...
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Chapter 038. Dysphagia (Part 4) Chapter 038. Dysphagia (Part 4)Table 38-2 Esophageal DysphagiaEsophageal Mechanical DysphagiaI. Wall defects A. Congenital B. Tracheoesophageal fistulaII. Intrinsic narrowingA. 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 esophagitisB. Webs and rings 1. Esophageal (congenital, inflammatory) 2. Lower esophageal mucosal ring (Schatzkis ring) 3. Eosinophilic esophagitis 4. Host-versus-graft disease, mucocutaneous disordersC. Benign strictures 1. Peptic 2. Caustic 3. Pill-induced 4. Inflammatory (Crohns 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 subclavianartery, 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, neuropathicintestinal pseudo-obstruction syndrome) 3. Contractile (muscular) lower esophageal ring Note: LES, lower esophageal sphincter.