Оглавление
Группа авторов. The Esophagus
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
The Esophagus
IN MEMORIAM
Contributors
Preface. The History of Esophagology
About the Companion Website
1 Symptom Overview and Quality of Life
Introduction
Esophageal anatomy and production of symptoms. Anatomy
Esophageal muscle and sphincters
Development of esophageal symptoms
Symptoms
Dysphagia
Patient history and physical examination
Esophageal dysphagia
Diagnostic approach
Odynophagia
Heartburn and regurgitation
Chest Pain
Globus
GERD and extraesophageal symptoms
Healthcare utilization and quality of life
Symptom and quality of life assessment tools
Conclusion
References
2 Diagnosis and Treatment of Esophageal Chest Pain
Introduction
Epidemiology
Gastroesophageal reflux. Pathophysiology
Diagnosis and treatment
Summary
Esophageal hypersensitivity. Pathophysiology
Treatment
Pharmacologic
Selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors
Tricyclic antidepressants
Trazadone
Theophylline
Emerging therapies
Non‐pharmacologic
Cognitive behavioral therapy
Coping skills training
Biofeedback therapy
Hypnotherapy
Other non‐pharmacologic treatments
Non‐pharmacologic summary
Conclusion
Dysmotility. Achalasia
Pathophysiology
Distal esophageal spasm
Pathophysiology
Hypercontractile (jackhammer) esophagus
Pathophysiology
Available treatment options for esophageal chest pain. Pharmacotherapy
Endoscopic and surgical management
Conclusion
References
Note
3 Disorders Causing Oropharyngeal Dysphagia
Introduction
Swallowing. Mechanisms
Control
Sensory afferent pathways
Central organizing center
Motor efferent pathways
Musculature
Presentation
Evaluation. Physical examination
Laboratory tests
Dynamic studies
Modified barium swallow
Videoendoscopy
Manometry
Ultrasonography
Management
Endoscopic and surgical management
Swallowing and postural techniques. Swallowing maneuvers and exercises
Multiple swallows
Supraglottic swallow
Mendelsohn’s maneuver
Shaker exercise
Swallowing against laryngeal restriction
Postural techniques
Cost‐effectiveness
Pharmacologic treatment
Diet and lifestyle
Conclusions
References
4 The Esophagus: Rumination Syndrome
Introduction
Definition, clinical presentation, and demographic characteristics
Differential diagnosis
Pathophysiology
Diagnosis
Treatment
Diaphragmatic breathing
Psychologic approaches
Medical therapy
Fundoplication
Conclusion
References
5 Functional Anatomy and Physiology of Swallowing and Esophageal Motility
Introduction
Swallowing
Swallowing pattern generator
Organizational structure and function
Sensory
Motor
Organization
Cortical and supramedullary influences
Oropharyngeal stage motor activity
Propulsion of the bolus
Protection of the airway
Upper esophageal sphincter. Anatomy and innervation
Functional motor activity
Basal pressures
Swallowing
Esophagopharyngeal reflexes
Esophageal stage motor activity. Esophageal body. Anatomy, structure, and innervation
Striated muscle
Smooth muscle
Functional motor activity. Primary peristalsis
Secondary peristalsis
Tertiary peristalsis
Afferent sensory stimulation
Muscle tone
Smooth muscle esophageal body: motor activity
Central control mechanisms
Intramural neural control mechanisms
Intramural myogenic (muscle) control mechanisms
Integration of central and peripheral mechanisms
Deglutitive inhibition
Lower esophageal sphincter
Anatomy and innervation. Phrenoesophageal membrane
Diaphragm
Intrinsic lower esophageal sphincter
Functional motor activity
Resting or basal pressure
Transient lower esophageal sphincter relaxations
Diaphragm
References
6 Radiology of the Pharynx and Esophagus
Introduction
Pharynx. Normal pharyngeal anatomy
Normal oral and pharyngeal motility
Neuromuscular disorders
Pouches and diverticula. Zenker’s diverticula
Killian–Jamieson diverticula and pouches
Lateral pharyngeal pouches and diverticula
Branchial pouch sinuses and branchial cleft fistulae
Inflammatory conditions
Lymphoid hyperplasia
Pharyngeal and cervical esophageal webs
Tumors. Benign tumors and cysts
Squamous cell carcinoma
Lymphoma
Radiation change
Esophagus. Technique
Gastroesophageal reflux disease
Reflux esophagitis
Scarring and strictures
Barrett’s esophagus
Infectious esophagitis. Candida esophagitis
Herpes esophagitis
Cytomegalovirus esophagitis
Human immunodeficiency virus esophagitis
Drug‐induced esophagitis
Eosinophilic esophagitis
Lichen planus
Radiation esophagitis
Caustic esophagitis
Other esophagitides
Benign tumors. Papilloma
Adenoma
Glycogenic acanthosis
Leiomyoma
Fibrovascular polyp
Duplication cyst
Malignant tumors. Esophageal carcinoma
Other malignant tumors
Lower esophageal rings
Diverticula
Pulsion diverticula
Traction diverticula
Esophageal intramural pseudodiverticula
Esophageal motility disorders. Achalasia
Diffuse esophageal spasm
Presbyesophagus
Varices
Uphill varices
Downhill varices
Foreign body impactions
Fistulae
Perforation
References
7 Special Endoscopic Imaging and Optical Techniques for Evaluating the Esophagus
Chromoendoscopy
Electronic chromoendoscopy
Confocal laser endomicroscopy (CLE)
Volumetric laser endomicroscopy (VLE)
Summary
References
8 High‐Resolution Manometry and Esophageal Pressure Topography
Acknowledgments
Introduction
Indications for esophageal manometry
Manometry study technique and protocol. The HRM assembly
Patient selection and preparation
Manometry catheter placement
Baseline evaluation
Test swallows
Interpretation of high‐resolution manometry and esophageal pressure topography
Step 1: Evaluate EGJ morphology and tone
Step 2: Apply HRM metrics to individual swallows
Step 3: Classify individual test swallows
Step 4: Step designation of an esophageal motility diagnosis
HRM/EPT beyond the Chicago classification. Application of esophageal manometry to gastroesophageal reflux disease: The Lyon Consensus
High‐resolution impedance manometry (HRIM)
Application of adjunctive or provocative maneuvers
Conclusions
References
9 Esophageal Testing Using Multichannel Intraluminal Impedance
Introduction
Basic principles
High‐resolution impedance manometry
Esophageal function testing using combined multichannel intraluminal impedance and manometry
Multichannel intraluminal impedance for assessment of bolus transit in esophageal function tests
Combined MII‐EM in belching and rumination
Combined multichannel intraluminal impedance and pH for detection of acid and nonacid gastroesophageal reflux
MII–pH catheter characteristics and placement
MII–pH interpretation
Clinical applications
Assessment of mucosal integrity using baseline impedance measured by MII‐pH catheter
Direct mucosal impedance measurement
References
10 Ambulatory Monitoring for Reflux
Introduction
Esophageal pH monitoring
Catheter‐based pH monitoring. Electrodes
Practical aspects
Interpretation: normal values
Proximal pH Recordings
Wireless pH monitoring
Technical aspects
Comparison between catheter and capsule
Tolerability and complications
Benefit of extended duration of recording
Clinical relevance of esophageal pH monitoring. pH monitoring off therapy
pH monitoring on therapy
Esophageal pH‐impedance monitoring
Technical aspects
Interpretation
Pharyngeal impedance
Clinical relevance of esophageal pH‐impedance monitoring. Studies off therapy
Studies on therapy
Novel impedance metrics
Esophageal bilirubin monitoring
Technical aspects
Clinical relevance of esophageal bilirubin monitoring
Symptom association analysis
GERD phenotypes
Pathological GERD
Reflux hypersensitivity
Functional heartburn/chest pain or alternate diagnosis
Borderline situations
Clinical applications. Typical symptoms
Supraesophageal symptoms
Cough
Asthma
ENT symptoms
References
11 New Diagnostic Tests for GERD
Introduction
Bile monitoring
Novel impedance parameters
Salivary pepsin
Mucosal integrity
Oropharyngeal pH monitoring
Narrow‐band imaging
The road ahead
References
12 Role of Histology and Cytology in Esophageal Diseases
Introduction
Normal esophagus
Esophagitis
Infectious esophagitis. Candida esophagitis
Herpes esophagitis
Cytomegalovirus esophagitis
Other types of infectious esophagitis
Radiation‐ and chemotherapy‐induced esophagitis
Pill/drug‐induced and corrosive esophagitis. Pill/drug‐related esophagitis
Corrosive esophagitis
Primary eosinophilic esophagitis
Primary lymphocytic esophagitis
Esophageal Involvement in Systemic Disease. Eosinophilic gastroenteritis
Crohn’s disease
Esophageal manifestations of dermatologic and collagen vascular diseases. Bullous diseases. Pemphigus vulgaris
Bullous pemphigoid
Lichen planus
Collagen vascular diseases. Scleroderma
Graft‐versus‐host disease
Gastroesophageal reflux esophagitis
Barrett’s esophagus
Diagnosis in esophageal mucosal biopsy
Barrett’s esophagus–related dysplasia and neoplasm
Diagnosis in esophageal mucosal biopsies
Negative for dysplasia
Indefinite for dysplasia
Positive for dysplasia
Intramucosal adenocarcinoma
Adenocarcinoma with submucosal invasion
Diagnostic challenges
Evaluation of endoscopic mucosal resection and endoscopic submucosal dissection specimens
Evaluation of esophageal mucosal biopsy following mucosal ablation therapy
Evaluation of esophageal cytology specimens in BE and BE‐related neoplasia
Other carcinomas and malignancies. Squamous cell carcinoma
Small cell carcinoma
Malignant melanoma
References
13 Achalasia
Definition
Epidemiology
Pathophysiology
Clinical manifestations
Diagnosis
Treatment
Pharmacological treatment. Smooth muscle relaxants
Botulinum toxin A
Pneumodilation
Laparoscopic Heller myotomy
Pneumodilation vs. laparoscopic Heller myotomy
Per‐oral endoscopic myotomy (POEM)
What to do if symptoms reoccur following successful initial treatment
Esophagectomy for end‐stage achalasia
Prognosis
To screen or not for esophageal cancer?
Guidelines
References
14 Non‐Achalasia Esophageal Motility Abnormalities
Introduction
Disorders with esophagogastric junction outflow obstruction other than achalasia. Esophagogastric junction outflow obstruction
Major disorders of peristalsis
Distal esophageal spasm
Hypercontractile peristalsis (jackhammer esophagus)
Treatment of distal esophageal spasm and jackhammer esophagus
Minor disorders of peristalsis
Ineffective esophageal motility
Fragmented peristalsis
Treatment of ineffective esophageal motility and fragmented peristalsis
Conclusions and future directions
References
15 Surgery for Esophageal Motor Disorders: Achalasia, DES, Jackhammer, and EGJOO
Introduction
Achalasia
Endoscopic botulinum toxin injection
Outcomes
Endoscopic pneumatic dilatation
Technique
Outcomes
Endoscopic stenting
Per‐oral endoscopic myotomy (POEM)
POEM technique
Mucosal incision
Submucosal tunneling
Myotomy
Mucosal closure
Outcomes
POEM vs. pneumatic dilation
Surgical esophageal myotomy
Technique
Outcomes
Heller myotomy vs. POEM
Heller myotomy vs. pneumatic dilation
Minimally invasive esophagectomy
Technique
Esophagogastric junction outflow obstruction
Distal esophageal spasm
Jackhammer esophagus
Conclusion
References
16 Esophageal Webs and Rings
Definitions
Proximal esophageal webs. Prevalence and etiology
Symptoms and diagnosis
Treatment
Plummer‐Vinson syndrome
Lower esophageal rings
Schatzki’s ring
Epidemiology, pathology, and pathogenesis
Presentation and diagnosis
Treatment
References
17 Esophageal Diverticula
Classification
Epidemiology
Anatomy. Proximal esophageal diverticula
Mid‐esophageal diverticula
Pathophysiology
Symptoms
Complications
Physical examination
Diagnostic studies. Contrast esophagogram
Esophagogastroduodenoscopy (EGD)
Esophageal manometry
Ultrasonography
Surgical management. Cricopharyngeal diverticulum
Mid‐esophageal diverticulum
Epiphrenic diverticulum
Post‐operative management
References
18 Esophageal Involvement in Systemic Diseases
Introduction
Connective tissue disorders
Systemic sclerosis (scleroderma)
Mixed connective tissue disease
Myositis
Sjogren’s syndrome
Systemic lupus erythematosus
Fibromyalgia
Endocrine disorders
Diabetes mellitus
Thyroid disease
Genetic syndromes
Down syndrome
Ehlers‐Danlos syndrome
Infiltrative disorders
Amyloidosis
Sarcoidosis
Inflammatory disorders
Crohn’s disease
Behcet’s disease
Mast cell disorders
Neuromuscular disorders
Myasthenia
Paraneoplastic syndromes
Parkinson’s disease
Conclusion
References
19 Clinical Spectrum and Diagnosis of GERD Phenotypes
Introduction
The current paradigm of gastroesophageal reflux disease. Definition and prevalence
The era of proton pump inhibitor therapy
Clinical spectrum of GERD
Clinical history
Esophageal syndromes of GERD
Extraesophageal syndromes of GERD
Clinical assessment for relevant comorbid conditions
Clinical history: phenotypes
Endoscopic evaluation
Endoscopic assessment of esophageal mucosa
Endoscopic assessment of the anti‐reflux barrier
Other roles of endoscopic assessment in GERD
Upper gastrointestinal endoscopy: phenotypes
Ambulatory reflux monitoring
Ambulatory reflux monitoring systems
Ambulatory reflux monitoring with or without acid suppression
Ambulatory reflux monitoring metrics
Correlation between symptoms and ambulatory reflux events
Reflux hypersensitivity
Ambulatory reflux monitoring: phenotypes
Stepwise framework to phenotyping across the GERD spectrum
Further esophageal physiologic testing. Esophageal manometry
Ambulatory reflux monitoring on acid suppression
Conclusion
References
20 Hiatus Hernia and Gastroesophageal Reflux Disease
Introduction
Anatomy of the diaphragm and the esophagogastric junction
Physiology of the esophagogastric junction
Hiatus hernia
Type I hiatus hernia
Type II and III hiatus hernias
Type IV hiatal hernia
Congenital diaphragmatic hernias
Sliding hiatus hernia and reflux disease
Diagnosis
Therapy
Conclusions
References
21 Pathophysiology of Gastroesophageal Reflux Disease: Motility Factors
Introduction
Sphincter mechanism at the esophagogastric junction (EGJ) Historical perspective
Morphology of the sphincter mechanism at the esophagogastric Junction (EGJ)
Gastroesophageal junction pressure under various physiologic conditions
Circumferential and axial asymmetry of the EGJ pressure
Neural control of the lower esophageal sphincter and crural diaphragm
Physiologic significance of the two lower esophageal sphincters at the EGJ
Mechanisms of gastroesophageal reflux
Transient lower esophageal sphincter relaxation (TLESR)
Characteristics of transient lower esophageal sphincter relaxation (TLESR)
Stimuli that trigger transient lower esophageal sphincter relaxations. Gastric distention
Pharyngeal mechanisms
Factors modulating the rate of transient lower esophageal sphincter relaxations
Neural pathways mediating transient lower esophageal sphincter relaxation: vagal control mechanisms
Effect of antireflux therapy on transient lower esophageal sphincter relaxation
Lower esophageal sphincter hypotension in reflux disease
Hiatus hernia and reflux disease
Compliance/opening function of LES and EGJ in GER disease
Role of esophageal peristalsis in reflux disease
Conclusions
References
22 Pathophysiology of Gastroesophageal Reflux Disease: Epithelial Factors
Introduction
Acid, pepsin, and bile acids: the epithelial triple threat
Development of the esophagus and its defensive players
Esophageal tissue resistance: epithelial factors and beyond. Pre‐epithelial defense
Epithelial defense
Postepithelial defense
Assessing the epithelial barrier: measurements of resistance, permeability, and intercellular spaces
Pathophysiology of GERD and reflux esophagitis: acid burn or cytokine sizzle? Acid burn: the traditional concept
Pathogenesis of GERD and acute reflux esophagitis: lessons from the rabbit model and GERD patients
Cytokine sizzle: the alternative concept
Pathogenesis of GERD and acute reflux esophagitis: lessons from the rat model and from GERD patients
Pathogenesis of GERD and acute reflux esophagitis: lessons from the human model
Hypoxia‐inducible factor‐2α: a key mediator of the cytokine sizzle in human reflux esophagitis
Conclusions and future directions
References
23 Duodenogastroesophageal Reflux
Introduction
The role of acid and pepsin. Animal studies
Human studies
The role of duodenal contents
Bile acids in the pathogenesis of Barrett’s esophagus and/or esophageal adenocarcinoma
In vitro
Bile acids in the pathogenesis of erosive and non‐erosive reflux disease
Impact of DGER on laryngeal and respiratory mucosa
Detection of DGER in humans
Endoscopy
Gastric measurements. Gastric pH
Gastric aspiration
Esophageal aspiration
Scintigraphy
Ambulatory pH monitoring
Ambulatory bilirubin monitoring (Bilitec)
Impedance‐pH monitoring
DGER and symptoms
DGER and bariatric surgery
Medical and surgical treatment
Conclusion
References
24 Helicobacter pylori and GERD
Introduction
Epidemiology of H. pylori and GERD
Pathobiology of H. pylori and GERD
Implication of eradication of H. pylori on de novo GERD
Implication of H. pylori eradication on patients with known GERD
H. pylori and Barrett’s esophagus
H. pylori and esophageal adenocarcinoma and gastroesophageal junction adenocarcinoma
Professional guidelines, recommendations, and updates
Conclusions
References
25 Medical Management of Gastroesophageal Reflux Disease
Introduction
Lifestyle modifications
Sleep
Food and weight
Alcohol
Summary
Pharmacologic therapy
Antacids
Sucralfate
Promotility therapy
Baclofen
Acid‐suppressive therapy
Acid production
H2‐receptor antagonists
Proton pump inhibitors (PPIs)
Clinical efficacy. pH control
Symptom relief
Healing of erosive esophagitis
Optimizing PPI efficacy
Long‐term management
Nocturnal GERD
Side Effects of PPIs
Newer antisecretory agents: potassium‐competitive acid blockers
References
26 Refractory Heartburn: Reflux Hypersensitivity and Functional Heartburn
Introduction
Functional heartburn
Definition
Epidemiology
Pathophysiology
Clinical presentation
Diagnosis
Treatment
Reflux hypersensitivity
Definition
Epidemiology
Pathophysiology
Clinical presentation
Diagnosis
Treatment
Overlap with GERD
References
27 Endoscopic Therapies for GERD
Introduction
Understanding GEJ anatomy and physiology
Radiofrequency energy treatment of GERD (Stretta)
Stretta mechanisms of action
Stretta patient selection
Stretta in altered anatomy
Stretta technical considerations
Stretta safety and clinical outcomes
Stretta summary
Trans‐oral incisionless fundoplication (TIF)
TIF mechanisms of action
TIF patient selection
TIF technical considerations
TIF safety and clinical outcomes
Concomitant laparoscopic hernia repair and TIF
Emerging applications for TIF
TIF summary
Endoscopic suturing for GERD
Gastro‐gastric plication mechanism of action
Evolution of full‐thickness endoscopic suturing for GERD
Conclusions
References
28 Behavioral Treatment of Oropharyngeal and Esophageal Disorders
Dysphagia. Swallow physiology
Oropharyngeal swallow assessment
Multiphase swallow assessment
Dysphagia rehabilitation principles
Indirect swallowing treatment. Diet modifications
Mealtime modifications
Postural strategies
Swallowing maneuvers
Direct swallowing treatment
Oral phase exercise
Pharyngeal phase exercise
Behavioral strategies for esophageal dysphagia
Aerophagia
Assessment of aerophagia
Behavioral treatment of aerophagia
Supragastric belching
Assessment of supragastric belching
Behavioral treatment of supragastric belching
Plan of care for supragastric belching
Rumination
Assessment of rumination
Behavioral treatment of rumination
Plan of care for rumination
Extraesophageal reflux
Behavioral treatment
EER and voice
Disorders of laryngeal hyper‐responsiveness. Vocal cord dysfunction
Plan of care for behavioral treatment of VCD
Chronic cough
Plan of care for behavioral treatment of chronic cough
Summary
References
29 Barrett’s Esophagus
Introduction
Definition and diagnostic criteria
Epidemiology
Pathogenesis and progression. Pathogenesis of metaplasia
The neoplastic progression
Dysplasia
Clinical Presentation. Clinical features
Endoscopic diagnosis
Management. Screening for BE
Surveillance for BE
Advanced imaging techniques
Chromoendoscopy
Narrow‐band imaging (electronic chromoendoscopy)
Confocal laser endomicroscopy
Additional enhanced imaging techniques
Treatment. Non‐dysplastic Barrett’s. Medical therapy
Surgical options
Chemopreventive agents and the AspECT trial
Treatment of dysplastic Barrett’s esophagus
Endoscopic eradication therapy
Endoscopic mucosal resection
Endoscopic submucosal dissection (ESD)
Endoscopic ablative techniques
Radiofrequency ablation
Cryotherapy
Argon plasma coagulation (APC)
Challenges In Management. Surveillance after EET
Future directions
References
30 Esophageal Strictures
Classification of strictures
Types of esophageal dilators
Techniques of esophageal dilation. Choosing the correct initial dilator size
The rule of three
Selection of dilators and need for fluoroscopy
Timing of dilation
Endpoint of dilation
Other tips for esophageal dilation
Complications of esophageal dilation
Simple strictures. Peptic strictures
Schatzki rings
Esophageal webs
Cricopharyngeal bars
Lichen planus
Eosinophilic esophagitis
Complex strictures. Post‐endoscopic therapy strictures
Post‐ablative strictures
Post‐operative strictures
Radiation‐induced strictures
Caustic strictures
Nasogastric tube strictures
Refractory strictures
Steroid injections
Incisional therapy
Temporary stents
Mitomycin C
Self dilation
Conclusions
References
31 ENT Complaints in GERD
Introduction
Prevalence
Pathophysiology
Diagnosis
Laryngoscopy
Confirmatory testing for EER/LPR
Endoscopy
Management
Surgical therapy
Cost
Conclusion
References
32 Pulmonary Complications of Gastroesophageal Reflux Disease
Introduction
Pathophysiology
Clinical presentations and evaluation
Therapy
Asthma and GERD
PPI and asthma
Reflux monitoring in asthma
Antireflux surgery in asthma
Pulmonary fibrosis and GERD
Reflux monitoring in IPF
Antireflux therapies in IPF
GERD and lung transplant
Reflux testing and lung transplantation
Antireflux therapy in lung transplantation
Conclusions
References
33 Pediatric Gastroesophageal Reflux Disease
Gastroesophageal reflux
Pathophysiology:
Epidemiology:
Complications
Diagnostic evaluation
Upper gastrointestinal radiography (UGI)
Nuclear scintigraphy
Reflux testing. pH probes
Multichannel intraluminal impedance with pH (pH‐MII)
Symptom association
Upper endoscopy with biopsy of the esophagus
Other diagnostic approaches
Treatment
Non‐pharmacologic therapies
Transpyloric feeds
Pharmacologic therapy. Acid suppression
Motility medications:
Surgical Therapy
Conclusion
References
34 Challenges in the Understanding and Application of Antireflux Surgery for GERD
Historical overview
Fundoplications
Tailored fundoplication
Post‐fundoplication side effects
Candidates for antireflux surgery
Application of surgical therapy to patients with GERD
Outcome with a fundoplication
Longevity of antireflux surgery
Antireflux surgery and Barrett’s esophagus
Impact of antireflux surgery on the development of intestinal metaplasia
Impact of antireflux surgery on intestinal metaplasia already present prior to surgery
Impact of antireflux surgery on low‐grade dysplasia
Impact of antireflux surgery on progression of Barrett’s and development of esophageal adenocarcinoma
Antireflux surgery in patients with Barrett’s: word of caution
Conclusions
References
35 New Surgical Treatments for GERD
Introduction
The importance of alternatives therapies
Limitations of Nissen fundoplication
Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter. MSA design
Initial design considerations. MSA is a sphincter‐augmentation therapy
MSA is a pressure‐release mechanism
LES length as a reflux barrier
Physiologic comparison to fundoplication
Design safety considerations
Initial surgical technique and results
Evolution of technique
The essential role of the crural diaphragmatic sphincter
Crural repair and evolution of surgical technique
Evolving concept of LINX sizing
Current MSA technique with restoration of the crural sphincter
Current approach to patient selection and perioperative management. Patient selection and preoperative evaluation
Esophageal peristalsis
Hernia size, Barrett’s, symptoms
Surgical training expertise
Perioperative management
Clinical results
Patient‐reported outcomes
Subjective outcomes
Objective outcomes. Reflux control
Manometric findings
Reproducibility
Comparison to PPIs
Comparison to fundoplication
Specific presenting symptoms
Hernia size
Barrett’s
Predictors of outcomes of MSA
Device safety
Foreign body reaction
Allergic reaction
Erosion
Comparison to other implants
Safety data on erosions
Other device limitations and concerns. MSA and MRI
Discontinuous device
Device migration
Other implants
Risks, side effects, and complications. Perioperative risks
Dysphagia
Reoperation after MSA implantation
Future directions
Magnetic sphincter augmentation – conclusions
Lower esophageal sphincter (LES) electrical neuromodulation therapy (LES‐ENT)
References
36 Obesity and Gastroesophageal Reflux Disease
Introduction
Obesity and GERD symptoms
Obesity and GERD‐related complications
Mechanical and non‐mechanical effects of obesity
Mechanical effects of obesity on the gastroesophageal junction
Non‐mechanical effects of obesity
Weight loss as GERD treatment
Conclusion
References
37 Tumors of the Esophagus
Introduction
Malignant esophageal cancers
Epidemiology
Pathogenesis
Clinical presentation and diagnosis
Staging of esophageal cancer
Restaging after initial chemoradiotherapy
Endoscopic treatment of esophageal cancer
Palliation of unresectable esophageal cancer
Other malignancies of the esophagus
Conclusions
Benign tumors of the esophagus
Esophageal leiomyomas
Granular cell tumors
Papillomas
Fibrovascular polyps
Other benign esophageal lesions
Conclusions
References
38 Endoscopic Treatment of Esophageal Cancer
Rationale for the endoscopic treatment of esophageal cancer
Methods used in the endoscopic treatment of esophageal carcinoma
Ablation techniques. Ablation of residual Barrett’s esophagus after resection of focal adenocarcinoma lesions
Endoscopic ablation of non‐resectable EAC
Adjuvant chemotherapy and radiation therapy
Outcomes of endoscopic treatment of early esophageal cancer. T1a (mucosal) adenocarcinoma
T1b (submucosal) adenocarcinoma
References
39 Surgical Treatment for Esophageal Cancer
Introduction
Diagnosis and screening
Staging
Evaluation of cT
Evaluation of cN
Evaluation of cM
Preoperative assessment of physiological status
Pulmonary function
Cardiovascular function
Liver function
Preoperative composite risk score and nomograms
Surgical therapy. Resection of primary tumor
Lymphadenectomy
Reconstruction
Surgical approach
Perioperative care
Morbidity and mortality
Recurrence
Quality of life
Neo‐adjuvant therapy
Pragmatic therapeutic strategy
Conclusions
Acknowledgment
References
40 Eosinophilic Esophagitis
Financial support
Introduction
Epidemiology
Incidence and prevalence
Risk factors
Diagnosis
Current diagnostic criteria and approach
Disease activity measures
Clinical features
Barium esophagram
Endoscopy
Endoluminal ultrasonography
Esophageal manometry
Impedance planimetry
Phenotypes
Histology
Pathogenesis
Natural history
Treatment. Endpoints
PPIs
Diet therapy
Swallowed topical corticosteroids
Anti‐IgE
CRTH2 antagonist
Anti‐IL‐5
Anti‐IL‐13
Anti‐IL‐4 receptor
Miscellaneous
Esophageal dilation
Maintenance therapy
Conclusion
References
41 Foreign Bodies
Introduction
Anatomical considerations
Clinical presentation
Diagnostic evaluation
Management. Preparing for endoscopy
Sedation considerations
Equipment
Overtubes
Food impactions
Sharp or pointed objects
Batteries
Magnets
Small, blunt, round objects
Coins
Other objects
Dishwasher or laundry pods
Narcotic packages
Management of complications
References
42 Medication‐Induced Esophageal Injury
Introduction
Mechanisms
Pathology
Clinical features and diagnosis
Prevention, treatment, and clinical course
Specific medications
Antibiotics
Bisphosphonates
NSAIDs
Other medications commonly associated with pill‐induced injury
Chemotherapy‐induced esophagitis
References
43 Esophagitis in the Immunocompromised Host
Introduction
Epidemiology
Predisposing factors
General considerations
Fungal infections. Candida species. Epidemiology
Pathology
Clinical manifestations
Complications
Diagnosis
Treatment
Prophylaxis
Drug resistance
Other fungi. Epidemiology
Pathology, clinical manifestations, and complications
Diagnosis
Treatment
Viral infections
Herpes simplex virus. Epidemiology
Pathology
Clinical manifestations and complications
Diagnosis
Treatment
Cytomegalovirus. Epidemiology
Pathology
Clinical manifestations and complications
Diagnosis
Therapy
Prophylaxis
Other viruses
Mycobacterial infections. Epidemiology
Pathology
Clinical manifestations and complications
Diagnosis
Treatment
Bacterial infections. Epidemiology
Pathology
Clinical manifestations and complications
Diagnosis
Treatment
Treponema pallidum
Protozoal infections
Selected HIV‐related esophageal disorders
Disorders associated with primary HIV infection
Idiopathic esophageal ulcer. Epidemiology
Pathology
Clinical manifestations and complications
Diagnosis
Treatment
References
44 Caustic Injuries of the Esophagus
Introduction
Incidence
Pathophysiology
Alkali‐induced injury
Acid‐induced injury
Determinants of severity
Risks of specific substances
Clinical presentation
Initial evaluation
Endoscopy
Computed tomography
Management. Stabilization and supportive care
No role for emetics, neutralizing agents, or corticosteroids
Nutrition
Surgery
Management of late complications
Esophageal stricture
Intralesional steroid injection
Mitomycin‐C injection
Esophageal stent
Esophageal cancer
Conclusion
References
45 Rupture and Perforation of the Esophagus
Introduction
Pathophysiology
Boerhaave syndrome
Esophageal obstruction
Ingestions
Trauma
Iatrogenic perforation
Clinical features and diagnosis
Clinical presentation
Diagnosis
Approach to management
Surgical management
Endoscopic management
Stent placement
Endoscopic clips
Endoscopic suturing
Alternative endoscopic methods
Prognosis
Summary
References
46 Cutaneous Diseases of the Esophagus
Introduction
Inflammatory mucocutaneous disorders of the skin and mucous membranes including the esophagus. Autoimmune mucocutaneous blistering disorders
Mucous membrane pemphigoid
Epidermolysis bullosa acquisita
Bullous systemic lupus erythematosus
Pemphigus vulgaris
Paraneoplastic autoimmune multiorgan syndrome (paraneoplastic pemphigus)
Lichen planus
Stevens Johnson syndrome and toxic epidermal necrolysis
Multisystem disorders that have both mucocutaneous and esophageal manifestations. Autoimmune connective tissue disorders. Systemic sclerosis
Dermatomyositis
Systemic lupus erythematosus
Mixed connective tissue disease
Behcet’s disease
Cutaneous paraneoplastic disorders associated with esophageal carcinoma. Bazex syndrome
Tylosis with esophageal cancer
Plummer‐Vinson‐Patterson‐Kelly syndrome
Dyskeratosis congenita
Other cutaneous paraneoplastic disorders
Genodermatoses with esophageal manifestations
References
47 Esophageal Disease in Older Patients
Introduction
Changes in esophageal physiology with aging. Motility. Upper esophageal sphincter/pharynx
Esophageal body
Lower esophageal sphincter
Sensory function
Gastroesophageal reflux disease in older patients
Changes in gastroesophageal reflux disease‐related physiology with aging
Role of Helicobacter pylori infection and other gastric factors
Obesity and aging
Differences in presentation
Cardiopulmonary concerns
Special considerations related to Barrett’s esophagus in older patients
Differences in treatment of older patients
Lifestyle and patient‐directed therapy
Medical therapy
Surgery
Dysphagia
Prevalence and importance
Oropharyngeal dysphagia
Central nervous system diseases
Stroke
Alzheimer’s disease
Parkinson’s disease
Multiple sclerosis
Thyroid disease
Other neuromuscular disorders
Myasthenia gravis
Amyotrophic lateral sclerosis
Idiopathic upper esophageal sphincter dysfunction
Local structural lesions
Zenker’s diverticulum
General approach to oropharyngeal dysphagia
Esophageal dysphagia
Achalasia
Distal esophageal spasm and related disorders
Esophagogastric junction outflow obstruction (EGJO)
Jackhammer esophagus
Scleroderma
Esophageal cancer
Peptic stricture
Rings and webs
Vascular compression
Medication‐induced esophageal injury
Miscellaneous conditions
Conclusions
References
Index. a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
r
s
t
u
v
w
x
z
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