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The Esophagus

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Страница 1 Table of Contents List of Tables List of Illustrations Guide Pages The Esophagus Страница 8Страница 9 Contributors Preface The History of Esophagology About the Companion Website Страница 13 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 Страница 109 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 {buyButton}

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