Esophageal diseases

Achalasia: Loss of neural structure of LES, difficulty in swallowing both solid and liquid food, EGD is the best initial test, barium is more accurate, manometry is most accurate. Txt: pneumatic dilation, botunilum toxin inject, eventually myotomy.

Esophageal cancer:
alcohol, smoking --> squamous cancer proximal
GERD, barret --> adenomous cancer distal
solid, then fluid, weight loss, hoarseness, hypercalcemia
DX: barium --> EGD -->CT-->bronchoscopy-->endoscopic US
TxT: surgical resection, 5-FU, radiation

Scleroderma: GERD + scleroderma Dx: motility study Txt: omeprazole + metoclopramide

Nutcraker esophagus: spasm, chest pain with cold water + dysphagia. Dx: barium(corkscrew) + manometry. Txt: calium channel blocker + reassurance

Rings and webs: non-progressive dysphagia, Dx Barrium, Txt: dilation + iron for PVS
ring: distal,
Web(PVS): proximal, Iorn deficiency anemia

esophagitis: candida(HIV, DB), odynophagia, Dx: empirical fluconazole response, then endoscopy
pill esophgitis: young treat with acne developes acute onset of odynophagia

Zenker diverticulum: outpocketing of posterior pharyngeal constrictor muscle, Dx: barrium, endoscopy and nasal gastric tube are contraindicated, Txt: surgical resection

Mallory-Weiss syndrom: painless upper GI bleeding, melenoma Dx: endoscopy, Txt: no treatment or injection of epinephrine or cauterization