Esophagus pathology includes:
- Tracheoesophageal fistula
- Esophageal fistula
- Esophageal web
- Zenker diverticulum
- Mallory-Weiss syndrome
- Esophageal varices
Tracheoesophageal Fistula
A tracheoesophageal fistula is a congenital abnormality.
The most typical form of tracheoesophageal fistula has proximal esophageal atresia and a distal esophagus that emerges from the trachea.
Symptoms of tracheoesophageal fistula include:
- Aspiration
- Polyhydramnios
- Vomiting
- Abdominal distension
Tracheoesophageal Fistula. J Marchn - Not altered. CC BY-SA 3.0
Esophageal Web
An esophageal web is a thin esophageal mucosa protrusion, most frequently in the upper esophagus.
Symptoms of esophageal web include:
- Dysphagia
- Coughing
There is increased risk of developing esophageal squamous cell cancer with esophageal web.
Plummer-Vinson syndrome is characterized by an esophageal web, beefy-red tongue from atrophic glossitis, and severe iron deficiency anemia.
Esophageal Web. Esophageal web stenosis in barium swallow examination lateral view. Hellerhoff - Not altered. CC BY-SA 3.0
Zenker Diverticulum
A Zenker diverticulum is a pharyngeal mucosa outgrowth caused by a muscle wall defect (false diverticulum).
Zenker diverticulum occurs at the intersection of the esophagus and pharynx, it rises above the upper esophageal sphincter.
Symptoms of Zenker diverticulum include:
- Dysphagia
- Obstruction
- Halitosis
Zenker Diverticulum. AP X-ray of a Zenker's diverticulum James Heilman, MD - Not altered. CC BY-SA 4.0
Mallory-Weiss Syndrome
Mallory-Weiss syndrome is a partial longitudinal mucosal rupture at the gastroesophageal (GE) junction involving the mucosa causes.
Mallory-Weiss syndrome is due to:
- Intense retching
- Intense vomiting
Mallory-Weiss syndrome risk factors include:
- Vomiting after extreme alcohol consumption
- Vomiting with bulimia
Mallory-Weiss syndrome presents with excruciating hematemesis.
Mallory-Weiss syndrome is a risk factor for Boerhaave syndrome.
Boerhaave syndrome occurs when a full thickness tear of the esophageal wall occurs.
Boerhaave syndrome results in air in the mediastinum and subcutaneous emphysema.
Mallory-Weiss Syndrome. Endoscopic image of Mallory-Weiss tear Samir. Not altered. CC BY-SA 3.0
Esophageal Varices
Esophageal varices are lower esophageal submucosal veins that are dilated develop as a result of portal hypertension.
The left gastric vein often serves as the distal esophageal vein’s conduit to the portal vein.
The left gastric vein backs up into the esophageal vein in portal hypertension, causing dilatation (varices).
Esophageal varices are symptomless, yet there is a possibility of rupture.
Ruptured esophageal varices have a painless hematemesis at onset.
Esophageal Varices. Axial CT showing esophageal varices in liver cirrhosis with portal hypertension Hellerhoff. Not altered. CC BY-SA 3.0
Esophageal Cancer
Esophageal cancer appears later in life (poor prognosis).
Symptoms of esophageal cancer include:
- Progressive dysphagia (solids to liquids)
- Weight gain
- Discomfort
- Hematemesis
Additionally, cough and hoarse voice (recurrent laryngeal nerve involvement) may be present with squamous cell cancer (tracheal involvement).
Esophageal cancer is usually squamous cell carcinoma (SCC).
Squamous cells proliferate malignantly in squamous cell carcinoma (SCC).
Squamous cell carcinoma (SCC) is the world’s most prevalent type of esophageal cancer.
Esophageal squamous cell carcinoma (SCC) occurs most frequently in the upper or middle portion of the esophagus.
Major risk factors for squamous cell carcinoma of the esophagus include:
- Tobacco (one of most common causes)
- Alcohol (most common cause)
- Strong tea
- Achalasia
- Digestive web (e.g., Plummer-Vinson syndrome)
- Esophageal damage (e.g. lye ingestion)
The level of the esophagus that is affected determines the location of the lymph node spread:
- Upper 1/3 – Cervical nodes
- Middle 1/3 – Mediastinal or tracheobronchial nodes
- Lower 1/3 – Celiac and gastric nodes
Esophageal Cancer. Esophageal cancer as shown by a filling defect during an upper GI series James Heilman, MD. Not altered. CC BY-SA 4.0
