Benign Lesions of the Esophagus Benign tumors of the esophagus are rare, accounting for less than 10% of all esophageal tumors and occurring with a prevalence of 0.5%. However, autopsy studies indicate that benign lesions occur in 8% of the adult population and may account for the higher frequency of individuals that remain undiagnosed and asymptomatic. Esophageal carcinoma is 50 times more prevalent than benign lesions.…

Esophageal Motility Disorders The connection between unexplained chest pain and esophageal spasm was first discovered by William Osler in 1892. Since then, multiple esophageal motility disorders have been encountered in clinical practice, with a wide range of symptoms, manometric findings, and responses ( Fig. 13.1 ). These disorders vary from minimal changes to extensive radiologic and manometric abnormalities. The etiology of motility disorders has yet to…

Hiatal hernias develop in 10% to 50% of the population with an average age of 48 for patients with a sliding hernia and 65 to 75 for a paraesophageal hernia. There are four types of hiatal hernias. Type 1, accounting for over 90% of all hernias, develops when the gastroesophageal junction (GEJ) slides above the diaphragm. The remaining hernias, 10%, are either type 3 or mixed…

Gastroesophageal Reflux Disease Gastroesophageal reflux is a normal occurrence involving the movement of gastric contents through the lower esophageal sphincter (LES) into the esophagus. Physiologic reflux is usually harmless until the process causes symptoms and physical changes in the esophagus; then typical reflux becomes a disease. Gastroesophageal reflux disease (GERD) is a common condition that may require long-term treatment. It accounts for 75% of diseases that…

Eosinophilic esophagitis (EOE) is a chronic inflammatory disorder propagated by interleukin-5 (IL-5); it is unrelated to gastroesophageal reflux disease (GERD). Formerly a rare disease initially described in children and young men, EOE has been diagnosed more frequently in the past 10 years. According to current estimates, EOE has an annual incidence of 10 per 100,000 in children and teenagers and 30 per 100,000 in the adult…

Esophageal varices are diagnosed in almost one-third of compensated cases and almost two-thirds of decompensated cases of cirrhosis. Bleeding may occur in one-third of cases and is related to the size of the varix and the severity of the liver disease. There is a 1 in 8 chance of bleeding annually if varices are present. Each bleed has up to a 20% risk of resulting in…

Esophageal perforation and rupture may occur from small penetrations after endoscopy; full-thickness ruptures may follow from a tear or penetration. Presentation, diagnosis, and treatment are variable. The rarity of the diagnosis and variability in clinical presentation often lead to diagnostic and treatment delays. This is especially true of spontaneous perforation, where the clinical suspicion is low. Evaluation for more common medical conditions—such as myocardial infarction, pneumonia,…

Each year in the United States, 34,000 people ingest caustic substances ( Fig. 7.1 ), leading to tissue destruction through liquefaction or coagulation reactions. The severity of destruction depends on the type, concentration, and amount of substance; whether it is in solid or liquid form; and the duration of contact with the esophageal mucosa. Ingestion of a caustic substance is the most common toxic exposure in…

More than 100,000 cases of ingested foreign bodies occur in the pediatric population each year. Although most are accidental, intentional ingestion starts in adolescence. Children under 5 years of age are often exposed to random household objects, and they often swallow coins; such cases were as high as 76% in one large study. Children also swallow toy parts, jewels, batteries, sharp objects (needles, pins, fish or…

Based on radiologic and endoscopic studies, esophageal diverticula have a prevalence of up to 3% of individuals. They may be classified according to cause (pulsion or traction), location (pharyngoesophageal, midesophageal, or epiphrenic), or wall component (full thickness [true diverticula] or mucosal/submucosal [pseudodiverticula]) ( Fig. 5.1 ). Zenker diverticula account for 70% of all esophageal diverticula. Open full size image Fig. 5.1 Esophageal Diverticula. Cricopharyngeal Diverticula Zenker,…

Esophageal Rings and Webs Esophageal rings and webs are growths of tissue that partially obstruct the lumen of the esophagus. The prevalence of esophageal rings and webs has not been determined, as most patients are asymptomatic. Most lesions are found incidentally at the time of a radiologic study or endoscopy in 18%. No consensus exists as to the cause, location, or significance of the rings. Rings…

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The most frequently encountered anomaly in the newborn is esophageal atresia (EA), which occurs with or without tracheoesophageal fistula (TEF). These lesions occur together in 96% of cases except in the case of H-type fistulas ( Fig. 2.1 ). The incidence of EA is 1 in 4500 live births with no gender predilection. Infants born with EA have a 95% chance of survival. TEF and EA…

Topographic Relations of the Esophagus The pharynx ends at the level of the cricoid cartilage and the sixth cervical vertebra (C6) and where the esophagus begins ( Figs. 1.1 and 1.2 ). On average, the esophagus is 40 cm (16 inch) long from the upper incisor teeth to the edge of the cardia of the stomach. The esophagus is divided, with the first part extending 16 cm from…