The Esophagus

Cover
Title Page
Copyright Page
Contents
Contributors
Preface: The History of Esophagology
About the Companion Website
Section 1 Esophageal Symptoms
	Chapter 1 Symptom Overview and Quality of Life
		Introduction
		Esophageal anatomy and production of symptoms
			Anatomy
			Development of esophageal symptoms
		Symptoms
			Dysphagia
			Odynophagia
			Heartburn and regurgitation
			Chest Pain
			Globus
			GERD and extraesophageal symptoms
		Healthcare utilization and quality of life
			Symptom and quality of life assessment tools
		Conclusion
		References
	Chapter 2 Diagnosis and Treatment of Esophageal Chest Pain
		Introduction
		Epidemiology
		Gastroesophageal reflux
			Pathophysiology
			Diagnosis and treatment
			Summary
		Esophageal hypersensitivity
			Pathophysiology
			Treatment
		Dysmotility
			Achalasia
			Distal esophageal spasm
			Hypercontractile (jackhammer) esophagus
		Available treatment options for esophageal chest pain
			Pharmacotherapy
			Endoscopic and surgical management
		Conclusion
		References
	Chapter 3 Disorders Causing Oropharyngeal Dysphagia
		Introduction
		Swallowing
			Mechanisms
			Control
			Musculature
		Presentation
		Evaluation
			Physical examination
			Laboratory tests
			Dynamic studies
			Modified barium swallow
			Videoendoscopy
			Manometry
			Ultrasonography
		Management
			Endoscopic and surgical management
			Swallowing and postural techniques
			Pharmacologic treatment
			Diet and lifestyle
		Conclusions
		References
	Chapter 4 The Esophagus: Rumination Syndrome
		Introduction
		Definition, clinical presentation, and demographic characteristics
		Differential diagnosis
		Pathophysiology
		Diagnosis
		Treatment
			Diaphragmatic breathing
			Psychologic approaches
			Medical therapy
			Fundoplication
		Conclusion
		References
Section 2 Esophageal Physiology and Testing
	Chapter 5 Functional Anatomy and Physiology of Swallowing and Esophageal Motility
		Introduction
		Swallowing
			Swallowing pattern generator
			Organizational structure and function
			Oropharyngeal stage motor activity
			Propulsion of the bolus
		Upper esophageal sphincter
			Anatomy and innervation
			Functional motor activity
		Esophageal stage motor activity
			Esophageal body
			Functional motor activity
			Smooth muscle esophageal body: motor activity
			Deglutitive inhibition
		Lower esophageal sphincter
			Anatomy and innervation
			Functional motor activity
		References
	Chapter 6 Radiology of the Pharynx and Esophagus
		Introduction
		Pharynx
			Normal pharyngeal anatomy
			Normal oral and pharyngeal motility
			Neuromuscular disorders
			Pouches and diverticula
			Inflammatory conditions
			Pharyngeal and cervical esophageal webs
			Tumors
		Esophagus
			Technique
			Gastroesophageal reflux disease
			Reflux esophagitis
			Scarring and strictures
			Barrett’s esophagus
			Infectious esophagitis
			Drug-induced esophagitis
			Eosinophilic esophagitis
			Lichen planus
			Radiation esophagitis
			Caustic esophagitis
			Other esophagitides
			Benign tumors
			Malignant tumors
			Lower esophageal rings
			Diverticula
			Esophageal motility disorders
			Foreign body impactions
			Fistulae
			Perforation
		References
	Chapter 7 Special Endoscopic Imaging and Optical Techniques for Evaluating the Esophagus
		Chromoendoscopy
		Electronic chromoendoscopy
		Confocal laser endomicroscopy (CLE)
		Volumetric laser endomicroscopy (VLE)
		Summary
		References
	Chapter 8 High-Resolution Manometry and Esophageal Pressure Topography
		Acknowledgments
		Introduction
		Indications for esophageal manometry
		Manometry study technique and protocol
			The HRM assembly
			Patient selection and preparation
			Manometry catheter placement
			Baseline evaluation
			Test swallows
		Interpretation of high-resolution manometry and esophageal pressure topography
			Step 1: Evaluate EGJ morphology and tone
			Step 2: Apply HRM metrics to individual swallows
			Step 3: Classify individual test swallows
			Step 4: Step designation of an esophageal motility diagnosis
		HRM/EPT beyond the Chicago classification
			Application of esophageal manometry to gastroesophageal reflux disease: The Lyon Consensus
			High-resolution impedance manometry (HRIM)
			Application of adjunctive or provocative maneuvers
		Conclusions
		References
	Chapter 9 Esophageal Testing Using Multichannel Intraluminal Impedance
		Introduction
		Basic principles
		High-resolution impedance manometry
		Esophageal function testing using combined multichannel intraluminal impedance and manometry
		Multichannel intraluminal impedance for assessment of bolus transit in esophageal function tests
		Combined MII-EM in belching and rumination
		Combined multichannel intraluminal impedance and pH for detection of acid and nonacid gastroesophageal reflux
			MII–pH catheter characteristics and placement
			MII–pH interpretation
			Clinical applications
			Assessment of mucosal integrity using baseline impedance measured by MII-pH catheter
			Direct mucosal impedance measurement
		References
	Chapter 10 Ambulatory Monitoring for Reflux
		Introduction
		Esophageal pH monitoring
			Catheter-based pH monitoring
			Proximal pH Recordings
			Wireless pH monitoring
			Clinical relevance of esophageal pH monitoring
		Esophageal pH-impedance monitoring
			Technical aspects
			Interpretation
			Pharyngeal impedance
			Clinical relevance of esophageal pH-impedance monitoring
			Novel impedance metrics
		Esophageal bilirubin monitoring
			Technical aspects
			Clinical relevance of esophageal bilirubin monitoring
		Symptom association analysis
			GERD phenotypes
			Clinical applications
		References
	Chapter 11 New Diagnostic Tests for GERD
		Introduction
		Bile monitoring
		Novel impedance parameters
		Salivary pepsin
		Mucosal integrity
		Oropharyngeal pH monitoring
		Narrow-band imaging
		The road ahead
		References
	Chapter 12 Role of Histology and Cytology in Esophageal Diseases
		Introduction
		Normal esophagus
		Esophagitis
			Infectious esophagitis
			Radiation- and chemotherapy-induced esophagitis
			Pill/drug-induced and corrosive esophagitis
			Primary eosinophilic esophagitis
			Primary lymphocytic esophagitis
		Esophageal Involvement in Systemic Disease
			Eosinophilic gastroenteritis
			Crohn’s disease
		Esophageal manifestations of dermatologic and collagen vascular diseases
			Bullous diseases
			Collagen vascular diseases
		Gastroesophageal reflux esophagitis
		Barrett’s esophagus
			Diagnosis in esophageal mucosal biopsy
			Barrett’s esophagus–related dysplasia and neoplasm
			Diagnosis in esophageal mucosal biopsies
			Diagnostic challenges
			Other carcinomas and malignancies
		References
Section 3 Motility Disorders
	Chapter 13 Achalasia
		Definition
		Epidemiology
		Pathophysiology
		Clinical manifestations
		Diagnosis
		Treatment
			Pharmacological treatment
			Pneumodilation
			Laparoscopic Heller myotomy
			Pneumodilation vs. laparoscopic Heller myotomy
			Per-oral endoscopic myotomy (POEM)
		What to do if symptoms reoccur following successful initial treatment
		Esophagectomy for end-stage achalasia
		Prognosis
		To screen or not for esophageal cancer?
		Guidelines
		References
	Chapter 14 Non-Achalasia Esophageal Motility Abnormalities
		Introduction
		Disorders with esophagogastric junction outflow obstruction other than achalasia
			Esophagogastric junction outflow obstruction
		Major disorders of peristalsis
			Distal esophageal spasm
			Hypercontractile peristalsis (jackhammer esophagus)
			Treatment of distal esophageal spasm and jackhammer esophagus
		Minor disorders of peristalsis
			Ineffective esophageal motility
			Fragmented peristalsis
			Treatment of ineffective esophageal motility and fragmented peristalsis
		Conclusions and future directions
		References
	Chapter 15 Surgery for Esophageal Motor Disorders: Achalasia, DES, Jackhammer, and EGJOO
		Introduction
		Achalasia
			Endoscopic botulinum toxin injection
			Endoscopic pneumatic dilatation
			Endoscopic stenting
			Per-oral endoscopic myotomy (POEM)
			POEM technique
			Surgical esophageal myotomy
			Minimally invasive esophagectomy
		Esophagogastric junction outflow obstruction
		Distal esophageal spasm
		Jackhammer esophagus
		Conclusion
		References
	Chapter 16 Esophageal Webs and Rings
		Definitions
		Proximal esophageal webs
			Prevalence and etiology
			Symptoms and diagnosis
			Treatment
		Plummer-Vinson syndrome
		Lower esophageal rings
		Schatzki’s ring
			Epidemiology, pathology, and pathogenesis
			Presentation and diagnosis
			Treatment
		References
	Chapter 17 Esophageal Diverticula
		Classification
		Epidemiology
		Anatomy
			Proximal esophageal diverticula
			Mid-esophageal diverticula
		Pathophysiology
			Symptoms
		Complications
		Physical examination
		Diagnostic studies
			Contrast esophagogram
			Esophagogastroduodenoscopy (EGD)
			Esophageal manometry
			Ultrasonography
		Surgical management
			Cricopharyngeal diverticulum
			Mid-esophageal diverticulum
			Epiphrenic diverticulum
		Post-operative management
		References
	Chapter 18 Esophageal Involvement in Systemic Diseases
		Introduction
		Connective tissue disorders
			Systemic sclerosis (scleroderma)
			Mixed connective tissue disease
			Myositis
			Sjogren’s syndrome
			Systemic lupus erythematosus
			Fibromyalgia
		Endocrine disorders
			Diabetes mellitus
			Thyroid disease
		Genetic syndromes
			Down syndrome
			Ehlers-Danlos syndrome
		Infiltrative disorders
			Amyloidosis
			Sarcoidosis
		Inflammatory disorders
			Crohn’s disease
			Behcet’s disease
			Mast cell disorders
		Neuromuscular disorders
			Myasthenia
			Paraneoplastic syndromes
			Parkinson’s disease
		Conclusion
		References
Section 4 Gastroesophageal Reflux Disease
	Chapter 19 Clinical Spectrum and Diagnosis of GERD Phenotypes
		Introduction
		The current paradigm of gastroesophageal reflux disease
			Definition and prevalence
			The era of proton pump inhibitor therapy
		Clinical spectrum of GERD
			Clinical history
			Endoscopic evaluation
			Ambulatory reflux monitoring
			Stepwise framework to phenotyping across the GERD spectrum
		Further esophageal physiologic testing
			Esophageal manometry
			Ambulatory reflux monitoring on acid suppression
		Conclusion
		References
	Chapter 20 Hiatus Hernia and Gastroesophageal Reflux Disease
		Introduction
		Anatomy of the diaphragm and the esophagogastric junction
		Physiology of the esophagogastric junction
		Hiatus hernia
			Type I hiatus hernia
			Type II and III hiatus hernias
			Type IV hiatal hernia
		Congenital diaphragmatic hernias
		Sliding hiatus hernia and reflux disease
		Diagnosis
		Therapy
		Conclusions
		References
	Chapter 21 Pathophysiology of Gastroesophageal Reflux Disease: Motility Factors
		Introduction
		Sphincter mechanism at the esophagogastric junction (EGJ)
			Historical perspective
			Morphology of the sphincter mechanism at the esophagogastric Junction (EGJ)
		Gastroesophageal junction pressure under various physiologic conditions
			Circumferential and axial asymmetry of the EGJ pressure
			Neural control of the lower esophageal sphincter and crural diaphragm
			Physiologic significance of the two lower esophageal sphincters at the EGJ
		Mechanisms of gastroesophageal reflux
			Transient lower esophageal sphincter relaxation (TLESR)
			Lower esophageal sphincter hypotension in reflux disease
		Hiatus hernia and reflux disease
		Compliance/opening function of LES and EGJ in GER disease
		Role of esophageal peristalsis in reflux disease
		Conclusions
		References
	Chapter 22 Pathophysiology of Gastroesophageal Reflux Disease: Epithelial Factors
		Introduction
		Acid, pepsin, and bile acids: the epithelial triple threat
		Development of the esophagus and its defensive players
		Esophageal tissue resistance: epithelial factors and beyond
			Pre-epithelial defense
			Epithelial defense
			Postepithelial defense
		Assessing the epithelial barrier: measurements of resistance, permeability, and intercellular spaces
		Pathophysiology of GERD and reflux esophagitis: acid burn or cytokine sizzle?
			Acid burn: the traditional concept
			Cytokine sizzle: the alternative concept
		Conclusions and future directions
		References
	Chapter 23 Duodenogastroesophageal Reflux
		Introduction
		The role of acid and pepsin
			Animal studies
		The role of duodenal contents
			Bile acids in the pathogenesis of Barrett’s esophagus and/or esophageal adenocarcinoma
			In vitro
			Bile acids in the pathogenesis of erosive and non-erosive reflux disease
		Impact of DGER on laryngeal and respiratory mucosa
		Detection of DGER in humans
			Endoscopy
			Gastric measurements
			Esophageal aspiration
			Scintigraphy
			Ambulatory pH monitoring
			Ambulatory bilirubin monitoring (Bilitec)
			Impedance-pH monitoring
			DGER and symptoms
			DGER and bariatric surgery
		Medical and surgical treatment
		Conclusion
		References
	Chapter 24 Helicobacter pylori and GERD
		Introduction
		Epidemiology of H. pylori and GERD
		Pathobiology of H. pylori and GERD
		Implication of eradication of H. pylori on de novo GERD
		Implication of H. pylori eradication on patients with known GERD
		H. pylori and Barrett’s esophagus
		H. pylori and esophageal adenocarcinoma and gastroesophageal junction adenocarcinoma
		Professional guidelines, recommendations, and updates
		Conclusions
		References
	Chapter 25 Medical Management of Gastroesophageal Reflux Disease
		Introduction
		Lifestyle modifications
			Sleep
			Food and weight
			Alcohol
			Summary
		Pharmacologic therapy
			Antacids
			Sucralfate
			Promotility therapy
			Baclofen
			Acid-suppressive therapy
			Acid production
			H2-receptor antagonists
			Proton pump inhibitors (PPIs)
			Clinical efficacy
		Long-term management
			Nocturnal GERD
			Side Effects of PPIs
			Newer antisecretory agents: potassium-competitive acid blockers
		References
	Chapter 26 Refractory Heartburn: Reflux Hypersensitivity and Functional Heartburn
		Introduction
		Functional heartburn
			Definition
			Epidemiology
			Pathophysiology
			Clinical presentation
			Diagnosis
			Treatment
		Reflux hypersensitivity
			Definition
			Epidemiology
			Pathophysiology
			Clinical presentation
			Diagnosis
			Treatment
		Overlap with GERD
		References
	Chapter 27 Endoscopic Therapies for GERD
		Introduction
		Understanding GEJ anatomy and physiology
		Radiofrequency energy treatment of GERD (Stretta)
			Stretta mechanisms of action
			Stretta patient selection
			Stretta in altered anatomy
			Stretta technical considerations
			Stretta safety and clinical outcomes
			Stretta summary
		Trans-oral incisionless fundoplication (TIF)
			TIF mechanisms of action
			TIF patient selection
			TIF technical considerations
			TIF safety and clinical outcomes
			Concomitant laparoscopic hernia repair and TIF
			Emerging applications for TIF
			TIF summary
		Endoscopic suturing for GERD
			Gastro-gastric plication mechanism of action
			Evolution of full-thickness endoscopic suturing for GERD
		Conclusions
		References
	Chapter 28 Behavioral Treatment of Oropharyngeal and Esophageal Disorders
		Dysphagia
			Swallow physiology
			Oropharyngeal swallow assessment
			Multiphase swallow assessment
			Dysphagia rehabilitation principles
			Indirect swallowing treatment
			Direct swallowing treatment
			Behavioral strategies for esophageal dysphagia
		Aerophagia
			Assessment of aerophagia
			Behavioral treatment of aerophagia
		Supragastric belching
			Assessment of supragastric belching
			Behavioral treatment of supragastric belching
			Plan of care for supragastric belching
		Rumination
			Assessment of rumination
			Behavioral treatment of rumination
			Plan of care for rumination
		Extraesophageal reflux
			Behavioral treatment
			EER and voice
		Disorders of laryngeal hyper-responsiveness
			Vocal cord dysfunction
			Chronic cough
		Summary
		References
	Chapter 29 Barrett’s Esophagus
		Introduction
		Definition and diagnostic criteria
		Epidemiology
		Pathogenesis and progression
			Pathogenesis of metaplasia
			The neoplastic progression
			Dysplasia
		Clinical Presentation
			Clinical features
			Endoscopic diagnosis
		Management
			Screening for BE
			Surveillance for BE
		Treatment
			Non-dysplastic Barrett’s
			Treatment of dysplastic Barrett’s esophagus
		Challenges In Management
			Surveillance after EET
			Future directions
		References
	Chapter 30 Esophageal Strictures
		Classification of strictures
		Types of esophageal dilators
		Techniques of esophageal dilation
			Choosing the correct initial dilator size
			The rule of three
			Selection of dilators and need for fluoroscopy
			Timing of dilation
			Endpoint of dilation
			Other tips for esophageal dilation
			Complications of esophageal dilation
		Simple strictures
			Peptic strictures
			Schatzki rings
			Esophageal webs
			Cricopharyngeal bars
			Lichen planus
			Eosinophilic esophagitis
		Complex strictures
			Post-endoscopic therapy strictures
			Post-ablative strictures
			Post-operative strictures
		Radiation-induced strictures
			Caustic strictures
			Nasogastric tube strictures
			Refractory strictures
		Steroid injections
		Incisional therapy
		Temporary stents
		Mitomycin C
		Self dilation
		Conclusions
		References
	Chapter 31 ENT Complaints in GERD
		Introduction
		Prevalence
		Pathophysiology
		Diagnosis
		Laryngoscopy
		Confirmatory testing for EER/LPR
		Endoscopy
		Management
		Surgical therapy
		Cost
		Conclusion
		References
	Chapter 32 Pulmonary Complications of Gastroesophageal Reflux Disease
		Introduction
		Pathophysiology
		Clinical presentations and evaluation
		Therapy
		Asthma and GERD
			PPI and asthma
			Reflux monitoring in asthma
			Antireflux surgery in asthma
		Pulmonary fibrosis and GERD
			Reflux monitoring in IPF
			Antireflux therapies in IPF
		GERD and lung transplant
			Reflux testing and lung transplantation
			Antireflux therapy in lung transplantation
		Conclusions
		References
	Chapter 33 Pediatric Gastroesophageal Reflux Disease
		Gastroesophageal reflux
			Pathophysiology:
			Epidemiology:
		Complications
		Diagnostic evaluation
			Upper gastrointestinal radiography (UGI)
			Nuclear scintigraphy
			Reflux testing
			Symptom association
			Upper endoscopy with biopsy of the esophagus
			Other diagnostic approaches
		Treatment
			Non-pharmacologic therapies
			Transpyloric feeds
		Pharmacologic therapy
			Acid suppression
			Motility medications:
		Surgical Therapy
		Conclusion
		References
	Chapter 34 Challenges in the Understanding and Application of Antireflux Surgery for GERD
		Historical overview
		Fundoplications
			Tailored fundoplication
			Post-fundoplication side effects
			Candidates for antireflux surgery
			Application of surgical therapy to patients with GERD
			Outcome with a fundoplication
		Longevity of antireflux surgery
		Antireflux surgery and Barrett’s esophagus
			Impact of antireflux surgery on the development of intestinal metaplasia
			Impact of antireflux surgery on intestinal metaplasia already present prior to surgery
			Impact of antireflux surgery on low-grade dysplasia
			Impact of antireflux surgery on progression of Barrett’s and development of esophageal adenocarcinoma
			Antireflux surgery in patients with Barrett’s: word of caution
		Conclusions
		References
	Chapter 35 New Surgical Treatments for GERD
		Introduction
			The importance of alternatives therapies
			Limitations of Nissen fundoplication
		Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter
			MSA design
			Initial surgical technique and results
			Evolution of technique
		Current approach to patient selection and perioperative management
			Surgical training expertise
			Perioperative management
			Clinical results
			Device safety
			Risks, side effects, and complications
			Future directions
			Magnetic sphincter augmentation – conclusions
		Lower esophageal sphincter (LES) electrical neuromodulation therapy (LES-ENT)
		References
	Chapter 36 Obesity and Gastroesophageal Reflux Disease
		Introduction
		Obesity and GERD symptoms
		Obesity and GERD-related complications
		Mechanical and non-mechanical effects of obesity
			Mechanical effects of obesity on the gastroesophageal junction
			Non-mechanical effects of obesity
		Weight loss as GERD treatment
		Conclusion
		References
Section 5 Malignant Disease
	Chapter 37 Tumors of the Esophagus
		Introduction
		Malignant esophageal cancers
			Epidemiology
			Pathogenesis
			Clinical presentation and diagnosis
			Staging of esophageal cancer
			Restaging after initial chemoradiotherapy
			Endoscopic treatment of esophageal cancer
			Palliation of unresectable esophageal cancer
			Other malignancies of the esophagus
		Conclusions
		Benign tumors of the esophagus
			Esophageal leiomyomas
			Granular cell tumors
			Papillomas
			Fibrovascular polyps
			Other benign esophageal lesions
		Conclusions
		References
	Chapter 38 Endoscopic Treatment of Esophageal Cancer
		Rationale for the endoscopic treatment of esophageal cancer
		Methods used in the endoscopic treatment of esophageal carcinoma
		Ablation techniques
			Ablation of residual Barrett’s esophagus after resection of focal adenocarcinoma lesions
			Endoscopic ablation of non-resectable EAC
		Adjuvant chemotherapy and radiation therapy
		Outcomes of endoscopic treatment of early esophageal cancer
			T1a (mucosal) adenocarcinoma
			T1b (submucosal) adenocarcinoma
		References
	Chapter 39 Surgical Treatment for Esophageal Cancer
		Introduction
		Diagnosis and screening
		Staging
			Evaluation of cT
			Evaluation of cN
			Evaluation of cM
		Preoperative assessment of physiological status
			Pulmonary function
			Cardiovascular function
			Liver function
			Preoperative composite risk score and nomograms
		Surgical therapy
			Resection of primary tumor
			Lymphadenectomy
			Reconstruction
			Surgical approach
			Morbidity and mortality
			Recurrence
			Quality of life
		Neo-adjuvant therapy
		Pragmatic therapeutic strategy
		Conclusions
		Acknowledgment
		References
Section 6 Miscellaneous
	Chapter 40 Eosinophilic Esophagitis
		Financial support
		Introduction
		Epidemiology
			Incidence and prevalence
			Risk factors
		Diagnosis
			Current diagnostic criteria and approach
			Disease activity measures
		Clinical features
			Barium esophagram
			Endoscopy
			Endoluminal ultrasonography
			Esophageal manometry
			Impedance planimetry
			Phenotypes
		Histology
		Pathogenesis
		Natural history
		Treatment
			Endpoints
			PPIs
			Diet therapy
			Swallowed topical corticosteroids
			Anti-IgE
			CRTH2 antagonist
			Anti-IL-5
			Anti-IL-13
			Anti-IL-4 receptor
			Miscellaneous
			Esophageal dilation
			Maintenance therapy
		Conclusion
		References
	Chapter 41 Foreign Bodies
		Introduction
		Anatomical considerations
		Clinical presentation
		Diagnostic evaluation
		Management
			Preparing for endoscopy
			Sedation considerations
			Equipment
			Overtubes
		Food impactions
		Sharp or pointed objects
		Batteries
		Magnets
		Small, blunt, round objects
		Coins
		Other objects
		Dishwasher or laundry pods
		Narcotic packages
		Management of complications
		References
	Chapter 42 Medication-Induced Esophageal Injury
		Introduction
		Mechanisms
		Pathology
		Clinical features and diagnosis
		Prevention, treatment, and clinical course
		Specific medications
			Antibiotics
			Bisphosphonates
			NSAIDs
			Other medications commonly associated with pill-induced injury
			Chemotherapy-induced esophagitis
		References
	Chapter 43 Esophagitis in the Immunocompromised Host
		Introduction
		Epidemiology
		Predisposing factors
		General considerations
		Fungal infections
			Candida species
			Other fungi
		Viral infections
			Herpes simplex virus
			Cytomegalovirus
			Other viruses
		Mycobacterial infections
			Epidemiology
			Pathology
			Clinical manifestations and complications
			Diagnosis
			Treatment
		Bacterial infections
			Epidemiology
			Pathology
			Diagnosis
			Treatment
		Treponema pallidum
		Protozoal infections
		Selected HIV-related esophageal disorders
			Disorders associated with primary HIV infection
			Idiopathic esophageal ulcer
		References
	Chapter 44 Caustic Injuries of the Esophagus
		Introduction
		Incidence
		Pathophysiology
			Alkali-induced injury
		Acid-induced injury
		Determinants of severity
			Risks of specific substances
		Clinical presentation
		Initial evaluation
			Endoscopy
			Computed tomography
		Management
			Stabilization and supportive care
			No role for emetics, neutralizing agents, or corticosteroids
			Nutrition
			Surgery
		Management of late complications
			Esophageal stricture
		Esophageal cancer
		Conclusion
		References
	Chapter 45 Rupture and Perforation of the Esophagus
		Introduction
		Pathophysiology
		Boerhaave syndrome
		Esophageal obstruction
		Ingestions
		Trauma
		Iatrogenic perforation
		Clinical features and diagnosis
			Clinical presentation
			Diagnosis
		Approach to management
		Surgical management
		Endoscopic management
		Stent placement
			Endoscopic clips
			Endoscopic suturing
			Alternative endoscopic methods
		Prognosis
		Summary
		References
	Chapter 46 Cutaneous Diseases of the Esophagus
		Introduction
		Inflammatory mucocutaneous disorders of the skin and mucous membranes including the esophagus
			Autoimmune mucocutaneous blistering disorders
		Multisystem disorders that have both mucocutaneous and esophageal manifestations
			Autoimmune connective tissue disorders
			Cutaneous paraneoplastic disorders associated with esophageal carcinoma
		References
	Chapter 47 Esophageal Disease in Older Patients
		Introduction
		Changes in esophageal physiology with aging
			Motility
			Sensory function
			Gastroesophageal reflux disease in older patients
		Changes in gastroesophageal reflux disease-related physiology with aging
			Role of Helicobacter pylori infection and other gastric factors
			Obesity and aging
			Differences in presentation
			Cardiopulmonary concerns
			Special considerations related to Barrett’s esophagus in older patients
		Differences in treatment of older patients
			Lifestyle and patient-directed therapy
			Medical therapy
			Surgery
		Dysphagia
			Prevalence and importance
			Oropharyngeal dysphagia
		Central nervous system diseases
			Stroke
			Alzheimer’s disease
			Parkinson’s disease
			Multiple sclerosis
			Thyroid disease
			Other neuromuscular disorders
			Myasthenia gravis
			Amyotrophic lateral sclerosis
		Idiopathic upper esophageal sphincter dysfunction
		Local structural lesions
		Zenker’s diverticulum
		General approach to oropharyngeal dysphagia
		Esophageal dysphagia
		Achalasia
		Distal esophageal spasm and related disorders
		Esophagogastric junction outflow obstruction (EGJO)
		Jackhammer esophagus
		Scleroderma
		Esophageal cancer
		Peptic stricture
		Rings and webs
		Vascular compression
		Medication-induced esophageal injury
		Miscellaneous conditions
		Conclusions
		References
Index
EULA