Management Of Dysphagia

Question 1

Briefly describe the anatomy of the esophagus

Answer 1

• Muscular tube from the pharynx to the stomach (Outer circular and Inner longitudinal).

• Has 2 sphincters (UES & LES)

• It is about 38-40cm in men and 36cm women.

Question 2

What are the 3 normal anatomic narrowing of the esophagus

Answer 2

• Cricopharyngeus
• Left mainstem/arch of aorta
• Diaphragmatic hiatus

Question 3

The angle between the lower esophagus and gastric fundus is called?

Answer 3

Angle of His

Question 4

Which area is the lower esophageal high pressure zone and what is the normal pressure in this zone

Answer 4

This is the 2cm of the abdominal esophagus.

Normal pressure in this zone is 15-30mmHg

Question 5

List the esophageal contractions and describe them

Answer 5

Primary peristalsis
Triggered voluntarily by swallowing

Secondary peristalsis
Triggered by esophageal distention or irritation. Also called Housekeeper waves

Tertiary contractions
They are abnormal and can be in response to swallowing or can be spontaneous.

Question 6

List the causes of dysphagia

Answer 6

1) Benign
• Congenital
• Acquired
2) Malignant

Question 7

List the (benign) congenital causes of dysphagia

Answer 7

1) Esophageal atresia (with or without tracheo esophageal fistula)

2) Congenital esophageal fistula

3) Poorly developed GE junction with GERD.

Question 8

List the (benign) acquired causes of esophageal dysphagia

Answer 8

Strictures
• Trauma
• Inflammatory diseases (infectious and eosinophilic esophagitis)
• GERD
• Motility disorder
• Acquired diverticulae

STIGMA

Question 9

For eosinophilic esophagitis, which finding on biopsy is diagnostic?

Answer 9

Eosinophil count of 20 eosinophils per hpf