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El. knyga: Esophagus

Associate editor David A. Katzka, Edited by Donald O. Castell (Hahnemann University, USA), Associate editor Michael F. Vaezi, Associate editor Stuart Spechler, Associate editor Phillip O. Katz, Associate editor Andre Smout, Edited by Joel E. Richter (University of South Florida, USA)

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Išleidimo metai: 06-May-2021
Leidėjas: Wiley-Blackwell
Kalba: eng
ISBN-13: 9781119599678

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Formatas: EPUB+DRM
Išleidimo metai: 06-May-2021
Leidėjas: Wiley-Blackwell
Kalba: eng
ISBN-13: 9781119599678

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THE ESOPHAGUS The Esophagus investigates the anatomy, physiology, and pathology of the esophagus. This sixth edition, revised and updated throughout, also explores the diagnosis and treatment of various esophageal conditions. It includes treatment guidelines approved by the two largest gastroenterology societies, the ACG and AGA, as befits a work co-edited by two former presidents of those organizations. Advancements in diagnostics are presented, as are developments in the surgical and drug therapies.

Presented in full colour, and boasting an unrivalled team of editors and contributing authors, The Esophagus Sixth Edition will find a home wherever the anatomy, physiology, and pathology of the esophagus are studied and taught.

This book is accompanied by a website containing all the figures from the book in PowerPoint format.

www.wiley.com/go/richter/esophagus6e

Praise for the Fifth Edition:

There is absolutely no doubt that this edition of the textbook will maintain its status as the go-to reference for esophageal conditions, and will remain a highly utilized and clinically useful resource for novice and experienced physicians and surgeons alike. (Gastroenterology, 1 July 2013)

Contributors

xxxiii

Preface: The History of Esophagology

xxxvii

Donald O. Castell

About the Companion Website

xxxviii

Part I Esophageal Symptoms

(58)

1 Symptom Overview and Quality of Life

(15)

John W. Jacobs Jr

Introduction

(1)

Esophageal anatomy and production of symptoms

(1)

Anatomy

(1)

Esophageal muscle and sphincters

(1)

Development of esophageal symptoms

(1)

Symptoms

(6)

Dysphagia

(1)

Patient history and physical examination

(1)

Esophageal dysphagia

(1)

Diagnostic approach

(1)

Odynophagia

(1)

Heartburn and regurgitation

(1)

Chest Pain

(1)

Globus

(1)

GERD and extraesophageal symptoms

(1)

Healthcare utilization and quality of life

(3)

Symptom and quality of life assessment tools

(3)

Conclusion

(1)

References

(5)

2 Diagnosis and Treatment of Esophageal Chest Pain

(20)

Edward C. Oldfield IV

Parth J. Parekh

David A. Johnson

Introduction

(1)

Epidemiology

(1)

Gastroesophageal reflux

(2)

Pathophysiology

(1)

Diagnosis and treatment

(2)

Summary

(1)

Esophageal hypersensitivity

(6)

Pathophysiology

(3)

Treatment

(1)

Pharmacologic

(1)

Non-pharmacologic

(1)

Conclusion

(1)

Dysmotility

(2)

Achalasia

(1)

Pathophysiology

(1)

Distal esophageal spasm

(1)

Pathophysiology

(1)

Hypercontractile (jackhammer) esophagus

(1)

Pathophysiology

(1)

Available treatment options for esophageal chest pain

(1)

Pharmacotherapy

(1)

Endoscopic and surgical management

(1)

Conclusion

(1)

References

(7)

3 Disorders Causing Oropharyngeal Dysphagia

(15)

Patrick Sanvanson

Reza Shaker

Introduction

(1)

Swallowing

(4)

Mechanisms

(2)

Control

(1)

Sensory afferent pathways

(1)

Central organizing center

(1)

Motor efferent pathways

(1)

Musculature

(1)

Presentation

(1)

Evaluation

(2)

Physical examination

(1)

Laboratory tests

(1)

Dynamic studies

(1)

Modified barium swallow

(1)

Videoendoscopy

(1)

Manometry

(1)

Ultrasonography

(1)

Management

(3)

Endoscopic and surgical management

(1)

Swallowing and postural techniques

(1)

Swallowing maneuvers and exercises

(1)

Postural techniques

(1)

Cost-effectiveness

(1)

Pharmacologic treatment

(1)

Diet and lifestyle

(1)

Conclusions

(1)

References

(4)

4 The Esophagus: Rumination Syndrome

(6)

Magnus Holland

David A. Katzka

Introduction

(1)

Definition, clinical presentation, and demographic characteristics

(1)

Differential diagnosis

(1)

Pathophysiology

(1)

Diagnosis

(1)

Treatment

(2)

Diaphragmatic breathing

(1)

Psychologic approaches

(1)

Medical therapy

(1)

Fundoplication

(1)

Conclusion

(1)

References

(2)

Part II Esophageal Physiology and Testing

(188)

5 Functional Anatomy and Physiology of Swallowing and Esophageal Motility

(36)

Arvind Rengarajan

C. Prakash Gyawali

Introduction

(1)

Swallowing

(4)

Swallowing pattern generator

(1)

Organizational structure and function

(1)

Sensory

(1)

Motor

(1)

Organization

(1)

Cortical and supramedullary influences

(1)

Oropharyngeal stage motor activity

(1)

Propulsion of the bolus

(1)

Protection of the nasal cavity

(1)

Protection of the airway

(1)

Upper esophageal sphincter

(5)

Anatomy and innervation

(2)

Functional motor activity

(1)

Basal pressures

(1)

Swallowing

(1)

Esophagopharyngeal reflexes

(1)

Esophageal stage motor activity

(8)

Esophageal body

(1)

Anatomy, structure, and innervation

(1)

Striated muscle

(1)

Smooth muscle

(1)

Functional motor activity

(1)

Primary peristalsis

(1)

Secondary peristalsis

(1)

Tertiary peristalsis

(1)

Afferent sensory stimulation

(1)

Muscle tone

(1)

Smooth muscle esophageal body: motor activity

(1)

Central control mechanisms

(1)

Intramural neural control mechanisms

(1)

Intramural myogenic (muscle) control mechanisms

(1)

Integration of central and peripheral mechanisms

(1)

Deglutitive inhibition

(1)

Lower esophageal sphincter

(5)

Anatomy and innervation

(1)

Phrenoesophageal membrane

(1)

Diaphragm

(1)

Intrinsic lower esophageal sphincter

(2)

Functional motor activity

(1)

Resting or basal pressure

(1)

Transient lower esophageal sphincter relaxations

(1)

Diaphragm

(1)

References

(14)

6 Radiology of the Pharynx and Esophagus

(51)

Marc S. Levine

Stephen E. Rubesin

Introduction

(1)

Pharynx

(17)

Normal pharyngeal anatomy

(2)

Normal oral and pharyngeal motility

(2)

Neuromuscular disorders

101

(2)

Pouches and diverticula

103

(1)

Zenker's diverticula

103

(1)

Killian-Jamieson diverticula and pouches

106

(1)

Lateral pharyngeal pouches and diverticula

107

(1)

Branchial pouch sinuses and branchial cleft fistulae

107

(1)

Inflammatory conditions

108

(1)

Lymphoid hyperplasia

108

(1)

Pharyngeal and cervical esophageal webs

108

(2)

Tumors

110

(1)

Benign tumors and cysts

110

(1)

Squamous cell carcinoma

110

(1)

Lymphoma

113

(1)

Radiation change

113

(1)

Esophagus

114

(29)

Technique

114

(1)

Gastroesophageal reflux disease

115

(1)

Reflux esophagitis

115

(1)

Scarring and strictures

116

(1)

Barrett's esophagus

117

(4)

Infectious esophagitis

121

(1)

Candida esophagitis

121

(1)

Herpes esophagitis

122

(1)

Cytomegalovirus esophagitis

123

(1)

Human immunodeficiency virus esophagitis

123

(1)

Drug-induced esophagitis

123

(2)

Eosinophilic esophagitis

125

(1)

Lichen planus

125

(1)

Radiation esophagitis

126

(1)

Caustic esophagitis

126

(1)

Other esophagitides

127

(1)

Benign tumors

128

(1)

Papilloma

128

(1)

Adenoma

128

(1)

Glycogenic acanthosis

128

(1)

Leiomyoma

129

(1)

Fibrovascular polyp

129

(1)

Duplication cyst

130

(1)

Malignant tumors

131

(1)

Esophageal carcinoma

131

(1)

Other malignant tumors

134

(1)

Lower esophageal rings

134

(1)

Diverticula

135

(1)

Pulsion diverticula

138

(1)

Traction diverticula

138

(1)

Esophageal intramural pseudodiverticula

138

(1)

Esophageal motility disorders

139

(1)

Achalasia

139

(1)

Diffuse esophageal spasm

140

(1)

Presbyesophagus

140

(1)

Varices

140

(1)

Foreign body impactions

141

(1)

Fistulae

142

(1)

Perforation

143

(1)

References

143

(5)

7 Special Endoscopic Imaging and Optical Techniques for Evaluating the Esophagus

148

(7)

John A. Dumot

John J. Vargo

Arvind J. Trindade

Chromoendoscopy

149

(1)

Electronic chromoendoscopy

149

(1)

Confocal laser endomicroscopy (CLE)

149

(4)

Volumetric laser endomicroscopy (VLE)

153

(1)

Summary

153

(1)

References

153

(2)

8 High-Resolution Manometry and Esophageal Pressure Topography

155

(17)

Dustin A. Carlson

Peter J. Kahrilas

Acknowledgments

155

(1)

Introduction

155

(1)

Indications for esophageal manometry

155

(1)

Manometry study technique and protocol

155

(2)

The HRM assembly

155

(1)

Patient selection and preparation

156

(1)

Manometry catheter placement

156

(1)

Baseline evaluation

157

(1)

Test swallows

157

(1)

Interpretation of high-resolution manometry and esophageal pressure topography

157

(6)

Step 1: Evaluate EGJ morphology and tone

158

(1)

Step 2: Apply HRM metrics to individual swallows

159

(1)

Step 3: Classify individual test swallows

160

(1)

Step 4: Step designation of an esophageal motility diagnosis

161

(2)

HRM/EPT beyond the Chicago classification

163

(4)

Application of esophageal manometry to gastroesophageal reflux disease: The Lyon Consensus

163

(1)

High-resolution impedance manometry (HRIM)

163

(2)

Application of adjunctive or provocative maneuvers

165

(2)

Conclusions

167

(1)

References

167

(5)

9 Esophageal Testing Using Multichannel Intraluminal Impedance

172

(16)

Mohamed Khalaf

Amit Agrawal

Introduction

172

(1)

Basic principles

172

(1)

High-resolution impedance manometry

173

(1)

Esophageal function testing using combined multichannel intraluminal impedance and manometry

173

(1)

Multichannel intraluminal impedance for assessment of bolus transit in esophageal function tests

174

(2)

Combined MII-EM in belching and rumination

176

(2)

Combined multichannel intraluminal impedance and pH for detection of acid and nonacid gastroesophageal reflux

178

(6)

MII-pH catheter characteristics and placement

180

(1)

MII-pH interpretation

180

(2)

Clinical applications

182

(1)

Assessment of mucosal integrity using baseline impedance measured by MII-pH catheter

182

(1)

Direct mucosal impedance measurement

183

(1)

References

184

(4)

10 Ambulatory Monitoring for Reflux

188

(20)

Frank Zerbib

John E. Pandolfino

Introduction

188

(1)

Esophageal pH monitoring

188

(6)

Catheter-based pH monitoring

189

(1)

Electrodes

189

(1)

Practical aspects

189

(1)

Interpretation: normal values

190

(1)

Proximal pH Recordings

190

(1)

Wireless pH monitoring

191

(1)

Technical aspects

191

(1)

Comparison between catheter and capsule

192

(1)

Tolerability and complications

192

(1)

Benefit of extended duration of recording

192

(1)

Clinical relevance of esophageal pH monitoring

192

(1)

pH monitoring off therapy

192

(1)

pH monitoring on therapy

193

(1)

Esophageal pH-impedance monitoring

194

(4)

Technical aspects

194

(1)

Interpretation

195

(1)

Pharyngeal impedance

195

(2)

Clinical relevance of esophageal pH-impedance monitoring

197

(1)

Studies off therapy

197

(1)

Studies on therapy

197

(1)

Novel impedance metrics

197

(1)

Esophageal bilirubin monitoring

198

(1)

Technical aspects

198

(1)

Clinical relevance of esophageal bilirubin monitoring

198

(1)

Symptom association analysis

199

(1)

GERD phenotypes

200

(1)

Pathological GERD

200

(1)

Reflux hypersensitivity

201

(1)

Functional heartburn/chest pain or alternate diagnosis

201

(1)

Borderline situations

201

(1)

Clinical applications

201

(2)

Typical symptoms

201

(1)

Supraesophageal symptoms

202

(1)

ENT symptoms

203

(1)

References

203

(5)

11 New Diagnostic Tests for GERD

208

(10)

Robert T. Kavitt

Michael F. Vaezi

Introduction

208

(1)

Bile monitoring

208

(1)

Novel impedance parameters

209

(1)

Salivary pepsin

210

(1)

Mucosal integrity

211

(1)

Oropharyngeal pH monitoring

212

(2)

Narrow-band imaging

214

(1)

The road ahead

214

(1)

References

214

(4)

12 Role of Histology and Cytology in Esophageal Diseases

218

(29)

Xiuli Liu

John R. Goldblum

Introduction

218

(1)

Normal esophagus

218

(1)

Esophagitis

219

(6)

Infectious esophagitis

220

(1)

Candida esophagitis

220

(1)

Herpes esophagitis

220

(1)

Cytomegalovirus esophagitis

221

(1)

Other types of infectious esophagitis

222

(1)

Radiation- and chemotherapy-induced esophagitis

222

(1)

Pill/drug-induced and corrosive esophagitis

223

(1)

Pill/drug-related esophagitis

223

(1)

Corrosive esophagitis

224

(1)

Primary eosinophilic esophagitis

224

(1)

Primary lymphocytic esophagitis

225

(1)

Esophageal Involvement in Systemic Disease

225

(1)

Eosinophilic gastroenteritis

225

(1)

Crohn's disease

226

(1)

Esophageal manifestations of dermatologic and collagen vascular diseases

226

(2)

Bullous diseases

226

(1)

Pemphigus vulgaris

226

(1)

Bullous pemphigoid

226

(1)

Lichen planus

226

(1)

Collagen vascular diseases

227

(1)

Scleroderma

227

(1)

Graft-versus-host disease

227

(1)

Gastroesophageal reflux esophagitis

228

(2)

Barrett's esophagus

230

(10)

Diagnosis in esophageal mucosal biopsy

230

(2)

Barrett's esophagus-related dysplasia and neoplasm

232

(1)

Diagnosis in esophageal mucosal biopsies

232

(1)

Negative for dysplasia

232

(1)

Indefinite for dysplasia

233

(1)

Positive for dysplasia

233

(1)

Intramucosal adenocarcinoma

234

(1)

Adenocarcinoma with submucosal invasion

234

(1)

Diagnostic challenges

235

(1)

Evaluation of endoscopic mucosal resection and endoscopic submucosal dissection specimens

235

(1)

Evaluation of esophageal mucosal biopsy following mucosal ablation therapy

235

(1)

Evaluation of esophageal cytology specimens in BE and BE-related neoplasia

236

(1)

Other carcinomas and malignancies

236

(1)

Squamous cell carcinoma

236

(1)

Small cell carcinoma

239

(1)

Malignant melanoma

240

(1)

References

240

(7)

Part III Motility Disorders

247

(86)

13 Achalasia

249

(16)

Guy E. Boeckxstaens

Albert J. Bredenoord

Definition

249

(1)

Epidemiology

249

(1)

Pathophysiology

249

(3)

Clinical manifestations

252

(1)

Diagnosis

252

(2)

Treatment

254

(5)

Pharmacological treatment

254

(1)

Smooth muscle relaxants

254

(1)

Botulinum toxin A

254

(1)

Pneumodilation

255

(1)

Laparoscopic Heller myotomy

256

(1)

Pneumodilation vs. laparoscopic Heller myotomy

257

(1)

Per-oral endoscopic myotomy (POEM)

258

(1)

What to do if symptoms reoccur following successful initial treatment

259

(1)

Esophagectomy for end-stage achalasia

259

(1)

Prognosis

259

(1)

To screen or not for esophageal cancer?

260

(1)

Guidelines

260

(1)

References

261

(4)

14 Non-Achalasia Esophageal Motility Abnormalities

265

(13)

Steven Clayton

Introduction

265

(1)

Disorders with esophagogastric junction outflow obstruction other than achalasia

265

(2)

Esophagogastric junction outflow obstruction

265

(2)

Major disorders of peristalsis

267

(4)

Distal esophageal spasm

268

(1)

Hypercontractile peristalsis (jackhammer esophagus)

269

(1)

Treatment of distal esophageal spasm and jackhammer esophagus

270

(1)

Minor disorders of peristalsis

271

(2)

Ineffective esophageal motility

271

(1)

Fragmented peristalsis

272

(1)

Treatment of ineffective esophageal motility and fragmented peristalsis

272

(1)

Conclusions and future directions

273

(1)

References

274

(4)

15 Surgery for Esophageal Motor Disorders: Achalasia, DES, Jackhammer, and EGJOO

278

(16)

Brett Parker

Lee L. Swanstrom

Introduction

278

(1)

Achalasia

278

(9)

Endoscopic botulinum toxin injection

279

(1)

Outcomes

279

(1)

Endoscopic pneumatic dilatation

279

(1)

Technique

280

(1)

Outcomes

280

(1)

Endoscopic stenting

280

(1)

Per-oral endoscopic myotomy (POEM)

280

(1)

POEM technique

281

(1)

Mucosal incision

281

(1)

Submucosal tunneling

281

(1)

Myotomy

281

(1)

Mucosal closure

282

(1)

Outcomes

282

(1)

POEM vs. pneumatic dilation

283

(1)

Surgical esophageal myotomy

283

(1)

Technique

283

(1)

Outcomes

284

(1)

Heller myotomy vs. POEM

285

(1)

Heller myotomy vs. pneumatic dilation

286

(1)

Minimally invasive esophagectomy

287

(1)

Technique

287

(1)

Esophagogastric junction outflow obstruction

287

(1)

Distal esophageal spasm

288

(1)

Jackhammer esophagus

289

(1)

Conclusion

289

(1)

References

290

(4)

16 Esophageal Webs and Rings

294

(10)

Mohamed Khalaf

Donald Castell

Definitions

294

(1)

Proximal esophageal webs

294

(2)

Prevalence and etiology

294

(1)

Symptoms and diagnosis

295

(1)

Treatment

295

(1)

Plummer-Vinson syndrome

296

(1)

Lower esophageal rings

297

(1)

Schatzki's ring

298

(2)

Epidemiology, pathology, and pathogenesis

298

(1)

Presentation and diagnosis

298

(1)

Treatment

299

(1)

References

300

(4)

17 Esophageal Diverticula

304

(8)

Tara Barry

Adham R. Saad

Vic Velanovich

Classification

304

(1)

Epidemiology

304

(1)

Anatomy

304

(1)

Proximal esophageal diverticula

304

(1)

Mid-esophageal diverticula

304

(1)

Lower esophageal diverticula (epiphrenic)

304

(1)

Pathophysiology

305

(1)

Symptoms

305

(1)

Complications

306

(1)

Physical examination

306

(1)

Diagnostic studies

306

(1)

Contrast esophagogram

306

(1)

Esophagogastroduodenoscopy (EGD)

307

(1)

Esophageal manometry

307

(1)

Ultrasonography

307

(1)

Surgical management

307

(3)

Cricopharyngeal diverticulum

307

(2)

Mid-esophageal diverticulum

309

(1)

Epiphrenic diverticulum

309

(1)

Post-operative management

310

(1)

References

311

(1)

18 Esophageal Involvement in Systemic Diseases

312

(21)

John O. Clarke

Introduction

312

(1)

Connective tissue disorders

312

(6)

Systemic sclerosis (scleroderma)

312

(4)

Mixed connective tissue disease

316

(1)

Myositis

316

(1)

Sjogren's syndrome

317

(1)

Systemic lupus erythematosus

318

(1)

Fibromyalgia

318

(1)

Endocrine disorders

318

(1)

Diabetes mellitus

318

(1)

Thyroid disease

319

(1)

Genetic syndromes

319

(1)

Down syndrome

319

(1)

Ehlers-Danlos syndrome

320

(1)

Infiltrative disorders

320

(2)

Amyloidosis

320

(2)

Sarcoidosis

322

(1)

Inflammatory disorders

322

(2)

Crohn's disease

322

(1)

Behcet's disease

323

(1)

Mast cell disorders

323

(1)

Neuromuscular disorders

324

(1)

Myasthenia

324

(1)

Paraneoplastic syndromes

324

(1)

Parkinson's disease

325

(1)

Conclusion

325

(1)

References

325

(8)

Part IV Gastroesophageal Reflux Disease

333

(300)

19 Clinical Spectrum and Diagnosis of GERD Phenotypes

335

(12)

Rena Yadlapati

Introduction

335

(1)

The current paradigm of gastroesophageal reflux disease

335

(1)

Definition and prevalence

335

(1)

The era of proton pump inhibitor therapy

335

(1)

Clinical spectrum of GERD

336

(5)

Clinical history

336

(1)

Esophageal syndromes of GERD

337

(1)

Extraesophageal syndromes of GERD

337

(1)

Clinical assessment for relevant comorbid conditions

338

(1)

Clinical history: phenotypes

338

(1)

Endoscopic evaluation

338

(1)

Endoscopic assessment of esophageal mucosa

338

(1)

Endoscopic assessment of the anti-reflux barrier

339

(1)

Other roles of endoscopic assessment in GERD

339

(1)

Upper gastrointestinal endoscopy: phenotypes

339

(1)

Ambulatory reflux monitoring

339

(1)

Ambulatory reflux monitoring systems

340

(1)

Ambulatory reflux monitoring with or without acid suppression

340

(1)

Ambulatory reflux monitoring metrics

340

(1)

Correlation between symptoms and ambulatory reflux events

341

(1)

Reflux hypersensitivity

341

(1)

Ambulatory reflux monitoring: phenotypes

341

(1)

Stepwise framework to phenotyping across the GERD spectrum

341

(1)

Further esophageal physiologic testing

341

(2)

Esophageal manometry

341

(1)

Ambulatory reflux monitoring on acid suppression

342

(1)

Conclusion

343

(1)

References

343

(4)

20 Hiatus Hernia and Gastroesophageal Reflux Disease

347

(11)

Wout O.A. Rohof

Andre J.P.M. Smout

Introduction

347

(1)

Anatomy of the diaphragm and the esophagogastric junction

347

(1)

Physiology of the esophagogastric junction

348

(1)

Hiatus hernia

349

(1)

Type I hiatus hernia

349

(1)

Type II and III hiatus hernias

350

(1)

Type IV hiatal hernia

350

(1)

Congenital diaphragmatic hernias

350

(1)

Sliding hiatus hernia and reflux disease

350

(2)

Diagnosis

352

(1)

Therapy

353

(1)

Conclusions

354

(1)

References

354

(4)

21 Pathophysiology of Gastroesophageal Reflux Disease: Motility Factors

358

(18)

Ravinder K. Mittal

Sabine Roman

Introduction

358

(1)

Sphincter mechanism at the esophagogastric junction (EGJ)

358

(2)

Historical perspective

358

(1)

Morphology of the sphincter mechanism at the esophagogastric Junction (EGJ)

358

(2)

Gastroesophageal junction pressure under various physiologic conditions

360

(3)

Circumferential and axial asymmetry of the EGJ pressure

361

(1)

Neural control of the lower esophageal sphincter and crural diaphragm

362

(1)

Physiologic significance of the two lower esophageal sphincters at the EGJ

363

(1)

Mechanisms of gastroesophageal reflux

363

(5)

Transient lower esophageal sphincter relaxation (TLESR)

363

(1)

Characteristics of transient lower esophageal sphincter relaxation (TLESR)

364

(1)

Stimuli that trigger transient lower esophageal sphincter relaxations

365

(1)

Gastric distention

365

(1)

Pharyngeal mechanisms

365

(1)

Factors modulating the rate of transient lower esophageal sphincter relaxations

366

(1)

Neural pathways mediating transient lower esophageal sphincter relaxation: vagal control mechanisms

366

(1)

Effect of antireflux therapy on transient lower esophageal sphincter relaxation

368

(1)

Lower esophageal sphincter hypotension in reflux disease

368

(1)

Hiatus hernia and reflux disease

368

(1)

Compliance/opening function of LES and EGJ in GER disease

369

(1)

Role of esophageal peristalsis in reflux disease

370

(1)

Conclusions

370

(1)

References

371

(5)

22 Pathophysiology of Gastroesophageal Reflux Disease: Epithelial Factors

376

(18)

Shere Paris

Rhonda F. Souza

Introduction

376

(1)

Acid, pepsin, and bile acids: the epithelial triple threat

376

(1)

Development of the esophagus and its defensive players

377

(1)

Esophageal tissue resistance: epithelial factors and beyond

378

(4)

Pre-epithelial defense

378

(1)

Epithelial defense

378

(3)

Postepithelial defense

381

(1)

Assessing the epithelial barrier: measurements of resistance, permeability, and intercellular spaces

382

(1)

Pathophysiology of GERD and reflux esophagitis: acid burn or cytokine sizzle?

382

(6)

Acid burn: the traditional concept

382

(1)

Pathogenesis of GERD and acute reflux esophagitis: lessons from the rabbit model and GERD patients

382

(2)

Cytokine sizzle: the alternative concept

384

(1)

Pathogenesis of GERD and acute reflux esophagitis: lessons from the rat model and from GERD patients

384

(1)

Pathogenesis of GERD and acute reflux esophagitis: lessons from the human model

385

(1)

Hypoxia-inducible factor-2a: a key mediator of the cytokine sizzle in human reflux esophagitis

387

(1)

Conclusions and future directions

388

(1)

References

388

(6)

23 Duodenogastroesophageal Reflux

394

(25)

Daniel Sifrim

Roberto Penagini

Introduction

394

(1)

The role of acid and pepsin

394

(2)

Animal studies

394

(1)

Human studies

395

(1)

The role of duodenal contents

396

(5)

Bile acids in the pathogenesis of Barrett's esophagus and/or esophageal adenocarcinoma

396

(2)

In vitro

398

(2)

Bile acids in the pathogenesis of erosive and non-erosive reflux disease

400

(1)

Impact of DGER on laryngeal and respiratory mucosa

401

(1)

Detection of DGER in humans

402

(8)

Endoscopy

402

(1)

Gastric measurements

402

(1)

Gastric pH

402

(1)

Gastric aspiration

403

(1)

Esophageal aspiration

403

(1)

Scintigraphy

403

(1)

Ambulatory pH monitoring

404

(1)

Ambulatory bilirubin monitoring (Bilitec)

405

(3)

Impedance-pH monitoring

408

(1)

DGER and symptoms

409

(1)

DGER and bariatric surgery

410

(1)

Medical and surgical treatment

410

(2)

Conclusion

412

(1)

References

413

(6)

24 Helicobacter pylori and GERD

419

(9)

Kristle Lee Lynch

Gaty W. Falk

Introduction

419

(1)

Epidemiology of H. pylori and GERD

419

(1)

Pathobiology of H. pylori and GERD

419

(2)

Implication of eradication of H. pylori on de novo GERD

421

(1)

Implication of H. pylori eradication on patients with known GERD

422

(1)

H. pylori and Barrett's esophagus

422

(1)

H. pylori and esophageal adenocarcinoma and gastroesophageal junction adenocarcinoma

422

(1)

Professional guidelines, recommendations, and updates

423

(1)

Conclusions

423

(1)

References

424

(4)

25 Medical Management of Gastroesophageal Reflux Disease

428

(16)

Felice Schnoll-Sussman

Philip O. Katz

Introduction

428

(1)

Lifestyle modifications

428

(3)

Sleep

429

(1)

Food and weight

430

(1)

Alcohol

430

(1)

Summary

430

(1)

Pharmacologic therapy

431

(5)

Antacids

431

(1)

Sucralfate

431

(1)

Promotility therapy

431

(1)

Baclofen

432

(1)

Acid-suppressive therapy

432

(1)

Acid production

432

(1)

H2-receptor antagonists

433

(1)

Proton pump inhibitors (PPIs)

433

(1)

Clinical efficacy

434

(1)

pH control

434

(1)

Symptom relief

434

(1)

Healing of erosive esophagitis

434

(1)

Optimizing PPI efficacy

434

(2)

Long-term management

436

(3)

Nocturnal GERD

436

(1)

Side Effects of PPIs

437

(2)

Newer antisecretory agents: potassium-competitive acid blockers

439

(1)

References

439

(5)

26 Refractory Heartburn: Reflux Hypersensitivity and Functional Heartburn

444

(21)

Fahmi Shibli

Ronnie Fass

Introduction

444

(1)

Functional heartburn

445

(8)

Definition

445

(1)

Epidemiology

446

(1)

Pathophysiology

447

(3)

Clinical presentation

450

(1)

Diagnosis

450

(1)

Treatment

451

(2)

Reflux hypersensitivity

453

(5)

Definition

454

(1)

Epidemiology

454

(1)

Pathophysiology

455

(1)

Clinical presentation

456

(1)

Diagnosis

456

(1)

Treatment

457

(1)

Overlap with GERD

458

(1)

References

459

(6)

27 Endoscopic Therapies for GERD

465

(27)

Kenneth J. Chang

Introduction

465

(1)

Understanding GEJ anatomy and physiology

466

(1)

Radiofrequency energy treatment of GERD (Stretta)

467

(7)

Stretta mechanisms of action

467

(1)

Stretta patient selection

468

(1)

Stretta in altered anatomy

468

(1)

Stretta technical considerations

469

(2)

Stretta safety and clinical outcomes

471

(3)

Stretta summary

474

(1)

Trans-oral incisionless fundoplication (TIF)

474

(9)

TIF mechanisms of action

474

(2)

TIF patient selection

476

(1)

TIF technical considerations

476

(3)

TIF safety and clinical outcomes

479

(2)

Concomitant laparoscopic hernia repair and TIF

481

(1)

Emerging applications for TIF

482

(1)

TIF summary

483

(1)

Endoscopic suturing for GERD

483

(4)

Gastro-gastric plication mechanism of action

484

(1)

Evolution of full-thickness endoscopic suturing for GERD

484

(3)

Conclusions

487

(1)

References

487

(5)

28 Behavioral Treatment of Oropharyngeal and Esophageal Disorders

492

(18)

Joy E. Gaziano

Dysphagia

492

(6)

Swallow physiology

492

(1)

Oropharyngeal swallow assessment

493

(1)

Multiphase swallow assessment

493

(2)

Dysphagia rehabilitation principles

495

(1)

Indirect swallowing treatment

495

(1)

Diet modifications

495

(1)

Mealtime modifications

496

(1)

Postural strategies

496

(1)

Swallowing maneuvers

496

(1)

Direct swallowing treatment

497

(1)

Oral phase exercise

497

(1)

Pharyngeal phase exercise

497

(1)

Behavioral strategies for esophageal dysphagia

498

(1)

Aerophagia

498

(2)

Assessment of aerophagia

499

(1)

Behavioral treatment of aerophagia

499

(1)

Supragastric belching

500

(1)

Assessment of supragastric belching

500

(1)

Behavioral treatment of supragastric belching

500

(1)

Plan of care for supragastric belching

500

(1)

Rumination

501

(1)

Assessment of rumination

501

(1)

Behavioral treatment of rumination

501

(1)

Plan of care for rumination

502

(1)

Extraesophageal reflux

502

(1)

Behavioral treatment

502

(1)

EER and Swallowing

502

(1)

EER and voice

502

(1)

Disorders of laryngeal hyper-responsiveness

503

(2)

Vocal cord dysfunction

503

(1)

Plan of care for behavioral treatment of VCD

504

(1)

Chronic cough

504

(1)

Plan of care for behavioral treatment of chronic cough

505

(1)

Summary

505

(1)

References

505

(5)

29 Barrett's Esophagus

510

(22)

Puja Sukhwani Elias

Stuart Jon Spechler

Introduction

510

(1)

Definition and diagnostic criteria

510

(1)

Epidemiology

511

(1)

Pathogenesis and progression

511

(4)

Pathogenesis of metaplasia

511

(2)

The neoplastic progression

513

(1)

Dysplasia

514

(1)

Clinical Presentation

515

(1)

Clinical features

515

(1)

Endoscopic diagnosis

515

(1)

Management

516

(3)

Screening for BE

516

(1)

Surveillance for BE

516

(1)

Advanced imaging techniques

517

(1)

Chromoendoscopy

517

(1)

Narrow-band imaging (electronic chromoendoscopy)

518

(1)

Confocal laser endomicroscopy

518

(1)

Additional enhanced imaging techniques

519

(1)

Treatment

519

(4)

Non-dysplastic Barrett's

519

(1)

Medical therapy

519

(1)

Surgical options

520

(1)

Chemopreventive agents and the AspECT trial

520

(1)

Treatment of dysplastic Barrett's esophagus

521

(1)

Endoscopic eradication therapy

521

(1)

Endoscopic mucosal resection

521

(1)

Endoscopic submucosal dissection (ESD)

522

(1)

Endoscopic ablative techniques

522

(1)

Radiofrequency ablation

522

(1)

Cryotherapy

523

(1)

Argon plasma coagulation (APC)

523

(1)

Challenges In Management

523

(2)

Surveillance after EET

523

(1)

Future directions

524

(1)

References

525

(7)

30 Esophageal Strictures

532

(22)

Sajiv Sethi

Joel Richter

Classification of strictures

532

(1)

Types of esophageal dilators

533

(1)

Techniques of esophageal dilation

534

(3)

Choosing the correct initial dilator size

534

(1)

The rule of three

534

(1)

Selection of dilators and need for fluoroscopy

535

(1)

Timing of dilation

535

(1)

Endpoint of dilation

535

(1)

Other tips for esophageal dilation

536

(1)

Complications of esophageal dilation

536

(1)

Simple strictures

537

(4)

Peptic strictures

537

(1)

Schatzki rings

538

(1)

Esophageal webs

539

(1)

Cricopharyngeal bars

539

(1)

Lichen planus

539

(1)

Eosinophilic esophagitis

540

(1)

Complex strictures

541

(2)

Post-endoscopic therapy strictures

541

(1)

Post-ablative strictures

541

(1)

Post-operative strictures

542

(1)

Radiation-induced strictures

543

(1)

Caustic strictures

543

(1)

Nasogastric tube strictures

544

(1)

Refractory strictures

544

(1)

Steroid injections

544

(1)

Incisional therapy

545

(1)

Temporary stents

545

(1)

Mitomycin C

546

(1)

Self dilation

547

(1)

Conclusions

547

(1)

References

548

(6)

31 ENT Complaints in GERD

554

(13)

C. Ambrose

Kenneth C. Fletcher

C. Gaelyn Garrett

Introduction

554

(1)

Prevalence

555

(1)

Pathophysiology

555

(1)

Diagnosis

555

(2)

Laryngoscopy

557

(2)

Confirmatory testing for EER/LPR

559

(2)

Endoscopy

561

(1)

Management

561

(1)

Surgical therapy

562

(1)

Cost

563

(1)

Conclusion

563

(1)

References

563

(4)

32 Pulmonary Complications of Gastroesophageal Reflux Disease

567

(14)

Walter W. Chan

Introduction

567

(1)

Pathophysiology

567

(2)

Clinical presentations and evaluation

569

(1)

Therapy

570

(1)

Asthma and GERD

570

(3)

PPI and asthma

571

(1)

Reflux monitoring in asthma

571

(1)

Antireflux surgery in asthma

572

(1)

Pulmonary fibrosis and GERD

573

(2)

Reflux monitoring in IPF

573

(1)

Antireflux therapies in IPF

574

(1)

GERD and lung transplant

575

(2)

Reflux testing and lung transplantation

575

(1)

Antireflux therapy in lung transplantation

576

(1)

Conclusions

577

(1)

References

577

(4)

33 Pediatric Gastroesophageal Reflux Disease

581

(10)

Rachel Rosen

Samuel Nurko

Gastroesophageal reflux

581

(1)

Pathophysiology

581

(1)

Epidemiology

581

(1)

Complications

582

(1)

Diagnostic evaluation

582

(2)

Upper gastrointestinal radiography (UGI)

582

(1)

Nuclear scintigraphy

582

(1)

Reflux testing

583

(1)

pH probes

583

(1)

Multichannel intraluminal impedance with pH (pH-MH)

583

(1)

Symptom association

583

(1)

Upper endoscopy with biopsy of the esophagus

584

(1)

Other diagnostic approaches

584

(1)

Treatment

584

(2)

Non-pharmacologic therapies

584

(2)

Transpyloric feeds

586

(1)

Pharmacologic therapy

586

(1)

Acid suppression

586

(1)

Motility medications

587

(1)

Surgical Therapy

587

(1)

Conclusion

588

(1)

References

588

(3)

34 Challenges in the Understanding and Application of Antireflux Surgery for GERD

591

(11)

Steven R. DeMeester

Tom R. DeMeester

Historical overview

591

(1)

Fundoplications

591

(5)

Tailored fundoplication

592

(1)

Post-fundoplication side effects

593

(1)

Candidates for antireflux surgery

594

(1)

Application of surgical therapy to patients with GERD

595

(1)

Outcome with a fundoplication

595

(1)

Longevity of antireflux surgery

596

(1)

Antireflux surgery and Barrett's esophagus

597

(1)

Impact of antireflux surgery on the development of intestinal metaplasia

597

(1)

Impact of antireflux surgery on intestinal metaplasia already present prior to surgery

597

(1)

Impact of antireflux surgery on low-grade dysplasia

598

(1)

Impact of antireflux surgery on progression of Barrett's and development of esophageal adenocarcinoma

598

(1)

Antireflux surgery in patients with Barrett's: word of caution

598

(1)

Conclusions

598

(1)

References

599

(3)

35 New Surgical Treatments for GERD

602

(22)

Reginald Bell

Introduction

602

(1)

The importance of alternatives therapies

602

(1)

Limitations of Nissen fundoplication

602

(1)

Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter

603

(7)

MSA design

603

(1)

Initial design considerations

603

(1)

LES length as a reflux barrier

605

(1)

Physiologic comparison to fundoplication

605

(1)

Design safety considerations

605

(1)

Initial surgical technique and results

605

(1)

Evolution of technique

606

(1)

The essential role of the crural diaphragmatic sphincter

606

(1)

Crural repair and evolution of surgical technique

606

(1)

Evolving concept of LINX sizing

607

(1)

Current MSA technique with restoration of the crural sphincter

608

(2)

Current approach to patient selection and perioperative management

610

(1)

Patient selection and preoperative evaluation

610

(1)

Surgical training expertise

611

(1)

Perioperative management

611

(1)

Clinical results

611

(1)

Patient-reported outcomes

611

(1)

Subjective outcomes

613

(1)

Objective outcomes

613

(1)

Reproducibility

614

(1)

Comparison to PPIs

614

(1)

Comparison to fundoplication

614

(1)

Specific presenting symptoms

615

(1)

Predictors of outcomes of MSA

616

(1)

Device safety

616

(1)

Foreign body reaction

616

(1)

Allergic reaction

616

(1)

Erosion

616

(1)

Comparison to other implants

616

(1)

Safety data on erosions

616

(1)

Other device limitations and concerns

617

(1)

Risks, side effects, and complications

618

(1)

Perioperative risks

618

(1)

Dysphagia

618

(1)

Reoperation after MSA implantation

618

(1)

Future directions

619

(1)

Magnetic sphincter augmentation - conclusions

619

(1)

Lower esophageal sphincter (LES) electrical neuromodulation therapy (LES-ENT)

619

(1)

References

620

(4)

36 Obesity and Gastroesophageal Reflux Disease

624

(9)

Hashem B. El-Serag

Aaron P. Thrift

Introduction

624

(1)

Obesity and GERD symptoms

625

(1)

Obesity and GERD-related complications

625

(1)

Mechanical and non-mechanical effects of obesity

626

(2)

Mechanical effects of obesity on the gastroesophageal junction

626

(2)

Non-mechanical effects of obesity

628

(1)

Weight loss as GERD treatment

628

(1)

References

629

(4)

Part V Malignant Disease

633

(46)

37 Tumors of the Esophagus

635

(16)

Michael S. Smith

Charles J. Lightdale

Introduction

635

(1)

Malignant esophageal cancers

635

(7)

Epidemiology

635

(1)

Pathogenesis

635

(2)

Clinical presentation and diagnosis

637

(1)

Staging of esophageal cancer

637

(2)

Restaging after initial chemoradiotherapy

639

(1)

Endoscopic treatment of esophageal cancer

640

(1)

Palliation of unresectable esophageal cancer

641

(1)

Other malignancies of the esophagus

642

(1)

Conclusions

642

(1)

Benign tumors of the esophagus

642

(2)

Esophageal leiomyomas

642

(1)

Granular cell tumors

643

(1)

Papillomas

643

(1)

Fibrovascular polyps

643

(1)

Other benign esophageal lesions

644

(1)

Conclusions

644

(1)

References

644

(7)

38 Endoscopic Treatment of Esophageal Cancer

651

(10)

Prasad G. Iyer

Kenneth K. Wang

Rationale for the endoscopic treatment of esophageal cancer

651

(1)

Methods used in the endoscopic treatment of esophageal carcinoma

652

(4)

Ablation techniques

656

(1)

Ablation of residual Barrett's esophagus after resection of focal adenocarcinoma lesions

656

(1)

Endoscopic ablation of non-resectable EAC

656

(1)

Adjuvant chemotherapy and radiation therapy

656

(1)

Outcomes of endoscopic treatment of early esophageal cancer

656

(2)

T1a (mucosal) adenocarcinoma

656

(2)

T1b (submucosal) adenocarcinoma

658

(1)

References

658

(3)

39 Surgical Treatment for Esophageal Cancer

661

(18)

Luigi Bonavina

Alberto Luporini

Introduction

661

(1)

Diagnosis and screening

661

(1)

Staging

661

(2)

Evaluation of cT

663

(1)

Evaluation of cN

663

(1)

Evaluation of cM

663

(1)

Preoperative assessment of physiological status

663

(2)

Pulmonary function

664

(1)

Cardiovascular function

665

(1)

Liver function

665

(1)

Preoperative composite risk score and nomograms

665

(1)

Surgical therapy

665

(4)

Resection of primary tumor

665

(1)

Lymphadenectomy

666

(1)

Reconstruction

666

(1)

Surgical approach

667

(1)

Perioperative care

667

(1)

Morbidity and mortality

668

(1)

Recurrence

669

(1)

Quality of life

669

(1)

Neo-adjuvant therapy

669

(1)

Pragmatic therapeutic strategy

670

(1)

Conclusions

671

(1)

Acknowledgment

672

(1)

References

672

(7)

Part VI Miscellaneous

679

40 Eosinophilic Esophagitis

681

(32)

Ikuo Hirano

Evan S. Dellon

Financial support

681

(1)

Introduction

681

(1)

Epidemiology

681

(2)

Incidence and prevalence

682

(1)

Risk factors

682

(1)

Diagnosis

683

(3)

Current diagnostic criteria and approach

684

(1)

Disease activity measures

685

(1)

Clinical features

686

(4)

Barium esophagram

686

(1)

Endoscopy

686

(2)

Endoluminal ultrasonography

688

(1)

Esophageal manometry

688

(1)

Impedance planimetry

689

(1)

Phenotypes

689

(1)

Histology

690

(1)

Pathogenesis

691

(1)

Natural history

692

(1)

Treatment

693

(8)

Endpoints

693

(1)

PPIs

694

(1)

Diet therapy

695

(1)

Swallowed topical corticosteroids

696

(1)

Anti-IgE

697

(1)

CRTH2 antagonist

697

(1)

Anti-IL-5

698

(1)

Anti-IL-13

698

(1)

Anti-IL-4 receptor

699

(1)

Miscellaneous

699

(1)

Esophageal dilation

699

(1)

Maintenance therapy

700

(1)

Conclusion

701

(1)

References

701

(12)

41 Foreign Bodies

713

(15)

Rene D. Gomez-Esquivel

Introduction

713

(1)

Anatomical considerations

714

(3)

Clinical presentation

717

(1)

Diagnostic evaluation

718

(1)

Management

719

(2)

Preparing for endoscopy

719

(1)

Sedation considerations

719

(1)

Equipment

719

(1)

Overtubes

720

(1)

Food impactions

721

(2)

Sharp or pointed objects

723

(1)

Batteries

723

(1)

Magnets

724

(1)

Small, blunt, round objects

725

(1)

Coins

725

(1)

Other objects

725

(1)

Dishwasher or laundry pods

725

(1)

Narcotic packages

726

(1)

Management of complications

726

(1)

References

726

(2)

42 Medication-Induced Esophageal, Injury

728

(8)

David A. Katzka

Introduction

728

(1)

Mechanisms

728

(1)

Pathology

729

(1)

Clinical features and diagnosis

729

(1)

Prevention, treatment, and clinical course

729

(1)

Specific medications

730

(2)

Antibiotics

730

(1)

Bisphosphonates

730

(1)

NSAIDs

731

(1)

Other medications commonly associated with pill-induced injury

731

(1)

Chemotherapy-induced esophagitis

732

(1)

References

732

(4)

43 Esophagitis in the Immunocompromised Host

736

(21)

James P. Callaway

C. Mel Wilcox

Introduction

736

(1)

Epidemiology

736

(1)

Predisposing factors

737

(1)

General considerations

737

(1)

Fungal infections

738

(6)

Candida species

738

(1)

Epidemiology

738

(1)

Pathology

738

(1)

Clinical manifestations

739

(1)

Complications

739

(1)

Diagnosis

739

(1)

Treatment

740

(1)

Prophylaxis

742

(1)

Drug resistance

742

(1)

Other fungi

743

(1)

Epidemiology

743

(1)

Pathology, clinical manifestations, and complications

743

(1)

Diagnosis

743

(1)

Treatment

743

(1)

Viral infections

744

(4)

Herpes simplex virus

744

(1)

Epidemiology

744

(1)

Pathology

744

(1)

Clinical manifestations and complications

744

(1)

Diagnosis

745

(1)

Treatment

745

(1)

Cytomegalovirus

745

(1)

Epidemiology

745

(1)

Pathology

745

(1)

Clinical manifestations and complications

746

(1)

Diagnosis

746

(1)

Therapy

746

(1)

Prophylaxis

747

(1)

Other viruses

747

(1)

Mycobacterial infections

748

(1)

Epidemiology

748

(1)

Pathology

748

(1)

Clinical manifestations and complications

748

(1)

Diagnosis

748

(1)

Treatment

748

(1)

Bacterial infections

748

(1)

Epidemiology

748

(1)

Pathology

749

(1)

Clinical manifestations and complications

749

(1)

Diagnosis

749

(1)

Treatment

749

(1)

Treponema pallidum

749

(1)

Protozoal infections

749

(1)

Selected HIV-related esophageal disorders

749

(2)

Disorders associated with primary HIV- infection

750

(1)

Idiopathic esophageal ulcer

750

(1)

Epidemiology

750

(1)

Pathology

750

(1)

Clinical manifestations and complications

750

(1)

Diagnosis

750

(1)

Treatment

750

(1)

References

751

(6)

44 Caustic Injuries of the Esophagus

757

(12)

Dhyanesh Patel

Introduction

757

(1)

Incidence

757

(1)

Pathophysiology

757

(1)

Alkali-induced injury

757

(1)

Acid-induced injury

758

(1)

Determinants of severity

759

(1)

Risks of specific substances

759

(1)

Clinical presentation

759

(1)

Initial evaluation

760

(2)

Endoscopy

760

(1)

Computed tomography

760

(2)

Management

762

(1)

Stabilization and supportive care

762

(1)

No role for emetics, neutralizing agents, or corticosteroids

762

(1)

Nutrition

762

(1)

Surgery

763

(1)

Management of late complications

763

(1)

Esophageal stricture

763

(1)

Intralesional steroid injection

763

(1)

Mitomycin-C injection

764

(1)

Esophageal stent

764

(1)

Esophageal cancer

764

(1)

Conclusion

764

(1)

References

764

(5)

45 Rupture and Perforation of the Esophagus

769

(20)

Phillip S. Ge

Gottumukkala S. Raju

Introduction

769

(1)

Pathophysiology

769

(1)

Boerhaave syndrome

769

(2)

Esophageal obstruction

771

(1)

Ingestions

771

(1)

Trauma

772

(1)

Iatrogenic perforation

772

(1)

Clinical features and diagnosis

773

(1)

Clinical presentation

773

(1)

Diagnosis

773

(1)

Approach to management

774

(1)

Surgical management

774

(1)

Endoscopic management

775

(1)

Stent placement

776

(7)

Endoscopic clips

777

(3)

Endoscopic suturing

780

(1)

Alternative endoscopic methods

781

(2)

Prognosis

783

(1)

Summary

783

(1)

References

783

(6)

46 Cutaneous Diseases of the Esophagus

789

(15)

Michael J. Camilleri

Introduction

789

(1)

Inflammatory mucocutaneous disorders of the skin and mucous membranes including the esophagus

789

(7)

Autoimmune mucocutaneous blistering disorders

789

(1)

Mucous membrane pemphigoid

789

(1)

Epidermolysis bullosa acquisita

791

(1)

Bullous systemic lupus erythematosus

792

(1)

Pemphigus vulgaris

792

(1)

Paraneoplastic autoimmune multiorgan syndrome (paraneoplastic pemphigus)

793

(1)

Lichen planus

793

(1)

Stevens Johnson syndrome and toxic epidermal necrolysis

795

(1)

Multisystem disorders that have both mucocutaneous and esophageal manifestations

796

(3)

Autoimmune connective tissue disorders

796

(1)

Systemic sclerosis

796

(1)

Dermatomyositis

797

(1)

Systemic lupus erythematosus

797

(1)

Mixed connective tissue disease

797

(1)

Behcet's disease

798

(1)

Cutaneous paraneoplastic disorders associated with esophageal carcinoma

798

(1)

Bazex syndrome

798

(1)

Tylosis with esophageal cancer

798

(1)

Plummer-Vinson-Patterson-Kelly syndrome

798

(1)

Dyskeratosis congenita

798

(1)

Other cutaneous paraneoplastic disorders

798

(1)

Genodermatoses with esophageal manifestations

799

(1)

References

799

(5)

47 Esophageal Disease in Older Patients

804

Kenneth R. DeVault

Sami R. Achem

Introduction

804

(1)

Changes in esophageal physiology with aging

805

(4)

Motility

805

(1)

Upper esophageal sphincter/pharynx

805

(1)

Esophageal body

805

(1)

Lower esophageal sphincter

806

(2)

Sensory function

808

(1)

Gastroesophageal reflux disease in older patients

808

(1)

Changes in gastroesophageal reflux disease-related physiology with aging

809

(2)

Role of Helicobacter pylori infection and other gastric factors

809

(1)

Obesity and aging

810

(1)

Differences in presentation

810

(1)

Cardiopulmonary concerns

810

(1)

Special considerations related to Barrett's esophagus in older patients

810

(1)

Differences in treatment of older patients

811

(2)

Lifestyle and patient-directed therapy

811

(1)

Medical therapy

811

(2)

Surgery

813

(1)

Dysphagia

813

(1)

Prevalence and importance

813

(1)

Oropharyngeal dysphagia

813

(1)

Central nervous system diseases

814

(7)

Stroke

814

(2)

Alzheimer's disease

816

(1)

Parkinson's disease

816

(2)

Multiple sclerosis

818

(1)

Thyroid disease

819

(1)

Other neuromuscular disorders

819

(1)

Myasthenia gravis

820

(1)

Amyotrophic lateral sclerosis

821

(1)

Idiopathic upper esophageal sphincter dysfunction

821

(15)

Local structural lesions

822

(1)

Zenker's diverticulum

822

(2)

General approach to oropharyngeal dysphagia

824

(1)

Esophageal dysphagia

825

(1)

Achalasia

826

(2)

Distal esophageal spasm and related disorders

828

(1)

Esophagogastric junction outflow obstruction (EGJO)

829

(1)

Jackhammer esophagus

830

(1)

Scleroderma

830

(2)

Esophageal cancer

832

(1)

Peptic stricture

832

(1)

Rings and webs

833

(1)

Vascular compression

834

(1)

Medication-induced esophageal injury

835

(1)

Miscellaneous conditions

836

(1)

Conclusions

836

(1)

References

837

Index

Editors-in-Chief

Joel E. Richter MD, FACP, MACG is Hugh F. Culverhouse Chair of Esophagology at the University of South Florida Morsani College of Medicine. Tampa, Florida USA

The late Donald O. Castell MD was Professor Emeritus of Medicine at the Medical University of South Carolina, Charleston, SC, USA

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