OTHER ESOPHAGEAL DISORDERS



Tumors. Carcinoma of the esophagus is dis­cussed in Chapter 41. Benign neoplasms (leiomy­oma, lipoma, papilloma, and fibrovascular po­lyps) are very rare and usually are asymptomatic or present as dysphagia.

Rings and Webs. Congenital rings and webs may occur in the proximal or distal (Schatzki’s ring) esophagus. The Plummer-Vinson syndrome consists of an upper esophageal web, dysphagia, and irondeficiency anemia. Most rings and webs are asymptomatic or may present as intermittent dysphagia for a bolus of meat. They can be dis­rupted mechanically with peroral dilators.
Esophageal Injury. Caustic ingestion causes severe esophageal injury leading to necrosis and eventual stricture formation. Steroids and broad-spectrum antibiotics are often used to treat caustic injuries, although their efficacy is uncertain.” Strictures often respond to peroral dilation.

Trauma. Vomiting may lead to mucosal (MalloryWeiss) or full-thickness (Boerhaave’s syn­drome) tears of the lower esophagus. Mallory-Weiss tears usually occur just below the gastro­esophageal junction. They often present with hemorrhage and will heal spontaneously. Esoph­ageal rupture often occurs just above the gastro­esophageal junction into the mediastinum and re­quires immediate diagnosis and surgical repair.

Infection. Esophageal infection with Candida or Herpesvirus can occur, particularly in the im-munosuppressed host, often with severe mucosal inflammation and ulceration. Severe odyno­phagia is a common symptom and dysphagia may occur. Diagnosis is best made by endoscopic vis­ualization and biopsy.