Dysphagia : Diagnosis and Treatment of Esophageal Motility Disorders

Dysphagia: Diagnosis and Treatment of Esophageal Motility Disorders provides a interdisciplinary overview of the diagnosis and management of dysphagia and other esophageal symptoms. All aspects of dysphagia are covered, with detailed consideration of both physiology and evaluation methods. Hot topics include coverage on the pharmacological causes of dysphagia, the physiology of normal swallowing, ambulatory pH monitoring as well as recurrent dysphagia after treatments. The content is grounded in evidence-based medicine that is the result of clinical outcome research, both prospective and randomized, making this the perfect reference for clinical researchers and a go-to for general surgeons, foreguts surgeons, thoracic surgeons and gastroenterologists. Presents a unified interdisciplinary approach to dysphagia covering perspectives from multiple specialties Provides in-depth analysis of radiologic, endoscopic and manometric evaluation of dysphagia including analysis of the Chicago Classification 4.0, which has changed previous paradigms Includes comprehensive coverage of dysphagia from evidence-based medicine that is the result of clinical outcome research, both prospective and randomized Half title Half title Copyright Dedication Contributors Preface CONTENTS Chapter 1 Normal swallowing physiology Introduction Functional anatomy Swallowing phases Airway protection Neurological control Conclusions References Chapter 2 Dysphagia and other esophageal symptoms Dysphagia and GERD Dysphagia and PEH Dysphagia and achalasia Symptom evaluation Upper endoscopy Barium swallow High-resolution manometry Ambulatory 24-hour pH monitoring Dysphagia and diverticula Conflict of Interest References Chapter 3 Radiologic evaluation of dysphagia Introduction Oropharyngeal Abnormalities Presbyesophagus Achalasia Scleroderma and other connective tissue diseases References Chapter 4 Endoscopic evaluation of dysphagia Introduction The importance of symptom assessment Etiologies of esophageal dysphagia Reliability of endoscopy in the assessment of dysphagia Endoscopic dilation of esophageal strictures Types of dilators Dilation for specific indications Anastomotic strictures following esophagectomy Achalasia Conclusions References Chapter 5 Manometric evaluation of dysphagia Introduction Equipment and performance Parameters evaluated Upper esophageal sphincter Esophageal body Lower esophageal sphincter pHmonitoring Classifications for esophageal motility disorders Dysphagia and motility disorders Achalasia Esophagogastric junction outflow obstruction Absent contractility Distal esophageal spasm Hypercontractile esophagus Ineffective esophageal motility Conclusions References Chapter 6 Achalasia Introduction Epidemiology and pathophysiology Clinical presentation Diagnostic evaluation Barium swallow Esophageal manometry Ambulatory pH monitoring Treatment Pharmacologic treatment Endoscopic treatment Endoscopic botulinum toxin injection Pneumatic dilatation Surgical treatment Laparoscopic Heller myotomy LHM versus POEM Esophagectomy Conclusions Conflict of Interest Acknowledgments References Chapter 7 Primary esophageal motility disorders beyond achalasia Disorders with impaired LES relaxation \(excluding Achalasia\) Disorders of peristalsis with normal EGJ outflow ^^e2^^80^^9cSpastic^^e2^^80^^9d EMD Treatment of ^^e2^^80^^9cSpastic^^e2^^80^^9d EMD Hypomotility disorders Treatment of hypomotile EMD Conclusions References Chapter 8 Zenker's diverticulum from pathophysiology to novel therapeutic approaches Introduction Clinical features Diagnosis Treatment Open transcervical approach Endoscopic approach Rigid endoscopic technique Flexible endoscopic technique Endoscopic septum division Conclusions Chapter 9 Gastroesophageal reflux disease and dysphagia Introduction Pathophysiology of GERD Clinical presentation of GERD Diagnostic work-up of patients with GERD and dysphagia Upper endoscopy Barium esophagram High-resolution manometry Ambulatory pH monitoring Gastric emptying study Management of patients with GERD and dysphagia Lifestyle modifications and medical therapy Endoscopic dilatation of GERD-related strictures Antireflux surgery Conclusions Conflict of Interest Acknowledgments References Chapter 10 Eosinophilic esophagitis focusing on dysphagia Introduction Epidemiology Pathogenesis Risk factors for EoE Diagnosis guidelines Clinical diagnosis of EoE EoE-like disease Endoscopic diagnosis Histopathological diagnosis Treatments Drugs Maintenance treatment Future perspectives Conclusion References Chapter 11 Pharmacologic causes of dysphagia Introduction Systemic effects of medications Smooth and striated muscle Blockade of afferent nerve conduction Xerostomia Extrapyramidal motor disturbances Alcohol Dysphagia due to therapeutic effects Antineoplastics and immunosuppressants Treatment toxicity Secondary infection Mucosal lesions due to allergic reactions Direct esophageal mucosal injury Antibiotics Clindamycin Rifampin Penicillins Antivirals Bisphosphonates Chemotherapeutics Aspirin and NSAIDs \(ibuprofen, naproxen, and indomethacin\) Quinidine Ascorbic acid Iron Potassium chloride Opioid-induced esophageal dysfunction \(OIED\) Epidemiology Pathophysiology of OIED Diagnosis Types of esophageal dysfunction Acute versus chronic opioid use Relationship between potency of opioid and OIED Management/treatment References Chapter 12 Once an achalasia patient always an achalasia patient: evaluation and treatment of recurrent symptoms Introduction Diagnostic evaluation Persistent dysphagia Recurrent dysphagia Treatment Conclusions Conflict of Interest References Chapter 13 Esophagectomy for recurrent dysphagia in esophageal motility disorders Introduction Indications Clinical presentation Diagnosis Decision making Preoperative optimization Operative approach Outcomes Functional long-term outcomes Conclusions References Index Benign esophageal diseases are a heterogenous group of disorders that maycause diverse symptoms, such as heartburn, regurgitation, and dysphagia.A motility disorder is often present, either primary such as in achalasia orsecondary such as in gastroesophageal reflux disease.The treatment of these disorders is based on a thorough work-up thatincludes a barium swallow, upper endoscopy, esophageal manometry, andpH monitoring. The goal is to characterize each disorder precisely, with theaim of tailoring treatment. The best results are obtained in centers wherea multidisciplinary team composed of radiologists, gastroenterologists, andsurgeons is present and able to offer different treatment options.The authors of the 13 chapters have been carefully selected as they areexperts in the treatment of these disorders, with many years of experience.Their recommendations for diagnosis and treatment are both based onevidence and personal experience.We do hope that our effort will be usefulfor both physicians in training as well as practicing gastroenterologists andsurgeons.