Treatments for Esophagus diseases
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Hospital statistics for Esophagus diseases:
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- 2.53% (322,277) of hospital episodes were for oesophagus, stomach and duodenum diseases in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 83% of hospital consultations for oesophagus, stomach and duodenum diseases required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 52% of hospital episodes for oesophagus, stomach and duodenum diseases were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 48% of hospital episodes for oesophagus, stomach and duodenum diseases were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 17% of hospital admissions for oesophagus, stomach and duodenum diseases required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
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Book Excerpts: Treatment of Esophagus diseases
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Tracheoesophageal fistula and esophageal atresia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Tracheoesophageal fistula and esophageal atresia require surgical correction and are usually surgical emergencies. The type and timing of surgical procedure depend on the nature of the anomaly, the patient’s general condition, and the presence of coexisting congenital defects. In premature neonates (nearly 33% of neonates with this anomaly are born prematurely) who are poor surgical risks, correction of combined tracheoesophageal fistula and esophageal atresia is done in two stages: first, gastrostomy (for gastric decompression, prevention of reflux, and feeding) and closure of the fistula; then, 1 to 2 months later, anastomosis of the esophagus.
Before and after surgery, positioning varies with the physician’s philosophy and the infant’s anatomy: the infant may be placed supine, with his head low to facilitate drainage, or with his head elevated to prevent aspiration.
The infant should receive I.V. fluids, as necessary, and appropriate antibiotics for superimposed infection.
Postoperative complications after correction of tracheoesophageal fistula include recurrent fistulas, esophageal motility dysfunction, esophageal stricture, recurrent bronchitis, pneumothorax, and failure to thrive. Esophageal motility dysfunction or hiatal hernia may develop after surgery to correct esophageal atresia.
Correction of esophageal atresia alone requires anastomosis of the proximal and distal esophageal segments in one or two stages. End-to-end anastomosis commonly produces postoperative stricture; end-to-side anastomosis is less likely to do so. If the esophageal ends are widely separated, treatment may include a colonic interposition (grafting a piece of the colon) or elongation of the proximal segment of the esophagus by bougienage. About 10 days after surgery, and again 1 and 3 months later, X-rays are required to evaluate the effectiveness of surgical repair.
Postoperative treatment includes placement of a suction catheter in the upper esophageal pouch to control secretions and prevent aspiration, maintaining the infant in an upright position to avoid reflux of gastric juices into the trachea, I.V. fluids (nothing by mouth), gastrostomy to prevent reflux and allow feeding, and appropriate antibiotics for pneumonia.
Postoperative complications may include impaired esophageal motility (in one-third of patients), hiatal hernia, and reflux esophagitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal diverticula:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of Zenker’s diverticulum is usually palliative and includes a bland diet, thorough chewing, and drinking water after eating to flush out the sac. However, severe symptoms or a large diverticulum necessitates surgery to remove the sac or facilitate drainage. An esophagomyotomy may be necessary to prevent recurrence.
A midesophageal diverticulum seldom requires therapy except when esophagitis aggravates the risk of rupture, in which case treatment includes antacids and an antireflux regimen: keeping the head elevated, maintaining an upright position for 2 hours after eating, eating small meals, controlling chronic coughing, and avoiding constrictive clothing.
Epiphrenic diverticulum requires treatment of accompanying motor disorders. Achalasia is treated by repeated dilations of the esophagus; acute spasm is controlled by anticholinergic administration and diverticulum excision; and dysphagia or severe pain are relieved by surgical excision or suspending the diverticulum to promote drainage. Treatment may also include parenteral feeding to improve the patient’s nutritional status.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Multimodal therapy is usually indicated. Whenever possible, treatment includes resection to maintain a passageway for food. This may require such radical surgery as esophagogastrectomy with jejunal or colonic bypass grafts. Palliative surgery may include a feeding gastrostomy. Chemotherapy with 5-fluorouracil or cisplatin may be used. Insertion of prosthetic tubes to bridge the tumor alleviates dysphagia. Other treatments to improve the patient's ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent) and photodynamic therapy.
Treatment complications may be severe. Surgery may precipitate an anastomotic leak, a fistula, pneumonia, and empyema. Rarely, radiation may cause esophageal perforation, pneumonitis and pulmonary fibrosis, or myelitis of the spinal cord. Prosthetic tubes may dislodge and perforate the mediastinum or erode the tumor.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Bleeding esophageal varices:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Blood transfusions, I.V. fluid replacement, endotracheal intubation and mechanical ventilation, Sengstaken-Blakemore or Minnesota tube, surgery, vasopressin
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Corrosive esophagitis and stricture:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Conservative treatment of corrosive esophagitis and stricture includes monitoring the patient’s condition; early endoscopy; administering corticosteroids, such as prednisone and hydrocortisone, to control inflammation and inhibit fibrosis; and using a broad-spectrum antibiotic, such as ampicillin, to protect the corticosteroid-immunosuppressed patient against infection by his own mouth flora.
Treatment may also include bougienage, a procedure in which a slender, flexible, cylindrical instrument called a bougie is passed into the esophagus to dilate it and minimize stricture. Some physicians begin bougienage immediately and continue it regularly to maintain a patent lumen and prevent stricture; others delay it for a week to avoid the risk of esophageal perforation.
Surgery is necessary immediately for esophageal perforation or later to correct stricture untreatable with bougienage. Corrective surgery may involve transplanting a piece of the colon to the damaged esophagus. However, even after surgery, stricture may recur at the site of the anastomosis.
Supportive treatment includes I.V. therapy to replace fluids or total parenteral nutrition while the patient can’t swallow, gradually progressing to clear liquids and a soft diet.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal diverticula:
Treatment
(Handbook of Diseases)
Treatment depends on the type of diverticulum. For example:
❑ A small, asymptomatic Zenker’s diverticulum may be observed. Treatment includes a bland diet, thorough chewing, and drinking water after eating to flush out the sac. Symptomatic patients may require surgery to remove the sac or to facilitate drainage. An esophagomyotomy to prevent recurrence is required in most cases.
❑ A midesophageal (traction) diverticulum seldom requires therapy except when esophagitis aggravates the risk of rupture. Then, treatment includes antacids and an antireflux regimen: keeping the head elevated, maintaining an upright position for 2 hours after eating, eating small meals, controlling chronic coughing, and avoiding constrictive clothing.
❑ Epiphrenic diverticulum requires treatment of accompanying motor disorders, such as achalasia, by repeated dilatations of the esophagus, of acute spasm by anticholinergic administration and diverticulum excision, and of dysphagia or severe pain by surgical excision; if there’s an associated hiatal hernia or incompetent lower esoph-ageal sphincter, an antireflux operation is performed. Calcium channel blockers may be used to relax smooth muscles, decrease esophageal pressure, and improve swallowing.
❑ Depending on the patient’s nutritional status, treatment may also include insertion of a nasogastric tube (passed carefully to prevent perforation) and tube feedings to prepare for the stress of surgery.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Esophageal cancer:
Treatment
(Handbook of Diseases)
Whenever possible, treatment includes resection to maintain a passageway for food. This may require such radical surgery as esophagogastrectomy with jejunal or colonic bypass grafts. Palliative surgery may include a feeding gastrostomy. Lash palliation decreases tumor size. Other therapies consist of radiation, chemotherapy with cisplatin, and the insertion of prosthetic tubes to bridge the tumor and alleviate dysphagia.
Treatment complications
Complications of treatment may be severe. Surgery may precipitate an anastomotic leak, a fistula, pneumonia, and empyema. Rarely, radiation may cause esophageal perforation, pneumonitis and pulmonary fibrosis, or myelitis of the spinal cord. Prosthetic tubes may dislodge and perforate the mediastinum or erode the tumor.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Esophagitis, corrosive (caustic):
Treatment
(Handbook of Diseases)
The patient may be treated conservatively through monitoring his condition, or he may require bougienage or surgery.
Bougienage
This procedure involves passing a slender, flexible, cylindrical instrument called a bougie into the esophagus to dilate it and minimize stricture.
CLINICAL TIP: Some physicians begin bougienage immediately and continue it regularly to maintain a patent lumen and prevent stricture; others delay it for a week to avoid the risk of esophageal perforation.
Surgery
Immediate surgery may be necessary for esophageal perforation; it may also be performed later to correct stricture that isn’t treatable with bougienage. Corrective surgery may involve transplanting a piece of the colon to the damaged esophagus. Even after surgery, stricture may recur at the site of the anastomosis.
Supportive treatment
Other treatment includes I.V. therapy, to replace fluids, and total parenteral nutrition while the patient can’t swallow, gradually progressing to clear liquids and a soft diet.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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