Chapter 038. Dysphagia (Part 4) pot

Chapter 038. Dysphagia
(Part 4)

Table 38-2 Esophageal Dysphagia
Esophageal Mechanical Dysphagia
I. Wall defects
A. Congenital
B. Tracheoesophageal fistula
II. Intrinsic narrowing
A. Inflammatory esophagitis
1. Viral (herpes simplex, varicella-zoster, cytomegalovirus)
2. Bacterial
3. Fungal (Candida)
4. Mucocutaneous bullous diseases
5. Caustic, chemical, thermal injury
6. Eosinophilic esophagitis
B. Webs and rings
1. Esophageal (congenital, inflammatory)
2. Lower esophageal mucosal ring (Schatzki's ring)
3. Eosinophilic esophagitis
4. Host-versus-graft disease, mucocutaneous disorders
C. Benign strictures
1. Peptic
2. Caustic
3. Pill-induced
4. Inflammatory (Crohn's disease, Candida, mucocutaneous lesions)
5. Ischemic
6. Postoperative
7. Post-radiation
8. Congenital
D. Tumors

1. Benign
2. Malignant
III. Extrinsic compression
A. Vascular compression (dysphagia lusoria, aberrant right subclavian
artery, right-sided aorta, left atrial enlargement, aortic aneurysm)
B. Posterior mediastinal mass
C. Postvagotomy hematoma and fibrosis
Esophageal Motor Dysphagia
I. Disorders of cervical esophagus
(see oropharyngeal motor disorders, Table 38-1)
II. Disorders of thoracic esophagus
A. Diseases of smooth muscle or excitatory nerves
1. Weak muscle contraction or LES tone
a. Idiopathic
b. Scleroderma and related collagen vascular diseases
c. Hollow visceral myopathy
d. Myotonic dystrophy
e. Metabolic neuromyopathy (amyloid, alcohol?, diabetes?)
f. Drugs: anticholinergics, smooth muscle relaxants
2. Enhanced muscle contraction
a. Hypertensive peristalsis (nutcracker esophagus)
b. Hypertensive LES, hypercontracting LES
B. Disorders of inhibitory innervation
1. Diffuse esophageal spasm
2. Achalasia
a. Primary
b. Secondary (Chagas' disease, carcinoma, lymphoma, neuropathic
intestinal pseudo-obstruction syndrome)
3. Contractile (muscular) lower esophageal ring
Note: LES, lower esophageal sphincter.