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esophagus

Esophagus is a muscular tube (food pipe) connecting mouth & pharynx with the stomach
The main function of the esophagus is transport of food & fluids
Length of esophagus in an adult is 25 cm
The esophagus runs behind the windpipe (trachea) and heart, and in front of the spine. Just before entering the stomach, the esophagus passes through the diaphragm
Upper & Lower ends of esophagus has sphincters, which acts as valves
- During swallowing, the upper sphincter opens so that food can pass to the stomach
- When the esophagus is not in use, the lower sphincter closes so that stomach contents do not flow back up from the stomach to the mouth

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Discussion

What are the common esophageal disorders?

Esophagitis - Inflammation of the esophagus
- Causes- GERD, certain drugs, infections etc.
Hiatal hernia - Hiatus is the esophageal opening in the diaphragm
- When it enlarges it may lead to hernia
- May or may not associated with GERD
GERD - Gastroesophageal reflux disease
- Reflux of gastric contents into the esophagus with bothersome symptoms
Achalasia cardia
- Failure of relaxation of lower esophageal sphincter when food reaches there
Esophageal varices
- In people with cirrhosis, veins in the esophagus may become engorged and bulge. These veins are vulnerable to life-threatening bleeding
Esophageal tumors
- Benign- Leiomyoma, GIST, schwannoma etc
- Malignant - Squamous cell carcinoma, adeno-carcinoma etc.

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What are the symptoms of esophageal disoders?

Dysphagia
- Difficulty in swallowing
- Common causes - cancers, achalasia cardia, strictures due to any cause
Retrosternal burning ( heart burn)
- Causes- GERD
Retro sternal pain
Odynophagia
- Pain during swallowing
- Causes - esophagitis due to any cause
Hemetemesis
- Vomiting of blood
- Eg. Varices, ulcers, esophagitis etc.

What are the common esophageal investigations?

Endoscopy +/- biopsy
- Evaluation of tumors, varices etc
24 hours pH monitoring or impedence manometry
- Evaluation of GERD
Manometry
- Evaluation of esophageal motility disorder
Barium swallow
- It is the X ray taken after swallowing radio opaque material such as barium sulfate
- For cancer, achalasia, corrosive strictures
CT scan
- For cancers
PET CT scan
- For cancers

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What are the common esophageal surgeries?

Esophagectomy
- Removal of esophagus eg. in cancers
Fundoplication
- Making a fundal wrap around the lower end
- For GERD / Hiatal hernia
Heller's cardiomyotomy
- Acahalasia cardia
Gastric/colon pullup
- For esophageal strictures

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