DOCSLIB.ORG

Swallowing and Esophageal Disorders

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Swallowing and Esophageal Disorders Treatment Guide Swallowing and Esophageal Disorders Esophageal disorders – especially those involving The Miller Family Heart & Vascular Institute is one swallowing problems – affect more than 15 million of the largest thoracic and cardiovascular specialty Americans of all ages. For many, they’re temporary groups in the world. The commitment of its physicians issues that can be managed with over-the-counter to research, education and patient care has led to medicines and lifestyle changes. But for others, they innovative treatment, better outcomes and improved are chronic concerns that plague daily life and can lead quality of life for patients. to more serious conditions. The good news is that esophageal disorders often USING THIS GUIDE can be successfully treated before long-term damage Please use this guide as a resource as you begin occurs. But it is important to get an early diagnosis and to learn about esophageal disorders and examine treatment plan. At Cleveland Clinic, we’ve assembled your treatment options. Remember, it is your right an entire team of all the specialists you need – as a patient to ask questions and to seek a second including gastroenterologists, radiologists, pathologists, opinion. thoracic surgeons and swallowing therapists – to offer leading-edge diagnosis and treatment options. Ranked No. 2 in the country and the top in Ohio by TABLE OF CONTENTS: U.S. News & World Report for gastroenterology, the Understanding swallowing problems ............................2 Digestive Disease Institute offers one of the few centers in the country dedicated to swallowing disorders. Esophagitis................................................................4 Through the Center for Swallowing & Esophageal GERD........................................................................4 Disorders, patients benefit from the extensive experience of physicians who diagnose and treat nearly Barrett’s esophagus.....................................................7 2,000 patients a year. Achalasia ..................................................................9 CLEVELAND CLINIC 216.444.7000 1 CLEVELAND CLINIC | GUIDE FOR SWALLOWING AND ESOPHAGEAL DISORDERS The mechanics of swallowing In order to understand diseases of the esophagus, it’s helpful to know what takes place during the swallowing process. The esophagus is a muscular tube through which food and drink pass from the mouth to the stomach. It is designed to push food into the stomach. To prevent food from moving backward – a condition called reflux – muscles at both ends of the esophagus close when food is not moving forward through them. These con- stricting, ring-shaped muscles are called sphincters. The sphincters act like valves and must constrict in an exact order for normal swallowing to occur. The upper muscles stop food from moving into the windpipe and voice box. The lower ones prevent food and stomach acid from moving back- ward into the esophagus. Problems with the relaxation of the sphincter muscles can result in choking or inability to eat. Difficulties with the constriction (tighten- ing) of the sphincter muscles cause reflux, which may result in symptoms such as heartburn or even damage to the esophagus. What are the symptoms of swallowing problems? There are a number of swallowing disorders that can cause a variety of symptoms. Early diagnosis and intervention are important to prevent long-term complications. See your physician if you experience any of the following: • Food sticking in the throat • Heartburn • Choking on food • Inability to swallow liquids • Pain when swallowing • Persistent cough or sore throat • Hoarseness or a gurgly voice during or after eating • A “lump in the throat” sensation • Wheezing without a history of asthma or lung problems What causes swallowing problems? More than 15 million Americans have a swallowing disorder, such as esophagi- tis, gastroesophageal reflux or achalasia. They can occur at any age. Swallowing problems may be temporary, or they may be an indication of a serious medical problem. There are many causes, including nerve and muscle problems, head and neck injuries and cancer. Or they may occur because of a stroke. Certain medica- tions can also contribute to the disorder. 2 SAME-DAY APPOINTMENTS ARE AVAILABLE. CALL 216.444.7000 CLEVELAND CLINIC CLEVELAND CLINIC | GUIDE FOR SWALLOWING AND ESOPHAGEAL DISORDERS How are swallowing problems Cleveland Clinic Center diagnosed? for Swallowing and Your doctor can determine the location and the extent of the problem based on Esophageal Disorders symptoms, a physical examination and diagnostic tests, which may include: • Barium swallow – This special video X-ray study shows the entire swallowing process and anatomy. It is a painless test that can pinpoint specific problem Cleveland Clinic has one of the areas and determine appropriate treatment. nation’s few centers dedicated to swallowing disorders. Heading a • Motility study – A test that records movement and pressures of the esophagus. team of four physician specialists • X-rays – Imaging of the neck, head or thyroid can help diagnose swallowing and two full-time nurses is problems. Sigurbjorn Birgisson, MD, MA. • pH monitoring (conventional 24-hour pH/impedance and 48-hour Bravo Our Swallowing Center team capsule) – This test measures and records the pH in your esophagus to determine collaborates with multidisciplinary if you have gastroesophageal reflux disease (GERD). It can also be done to deter- specialists, including radiologists, mine the effectiveness of medications or surgical treatment for GERD. otolaryngologists, thoracic and general surgeons, pathologists, • Endoscopy – This test uses a long, flexible lighted tube with a camera called an speech pathologists and others, endoscope to look at the esophagus. to manage more than 2,500 • Endoscopic ultrasound – A type of ultrasound testing to determine the nature patients a year. Monthly meetings and extent of tumors and other lesions. gather the center’s staff with these colleagues from other specialties to discuss the management of How are swallowing problems treated? complex cases. “These sessions are stimulating,” Sometimes just learning different physical techniques is enough to improve swallow- says Dr. Birgisson, “and ing ability. Other times, and depending on the precise ailment, medical intervention, underscore the broad expertise and/or surgery may be needed. Here is a closer look at each type of treatment: and resources we can bring to PHYSICAL TECHNIQUES bear for patients with the most challenging swallowing and A swallowing therapist can tailor these general strategies to your particular situation: esophageal disorders.” • Avoid eating when tired or stressed • Change head position and posture when swallowing (chin to chest is usually best) • Minimize head movements • Eat smaller, more frequent meals • Lubricate dry food by mixing it with a sauce • Always swallow all of the food in your mouth before taking another bite • Do not eat foods that will stick together • Thicken liquids to make them easier to swallow MEDICAL TREATMENT Sometimes, medical interventions are needed. For instance, stretching the esopha- gus can be done without surgery. Also, medications are effective for some people. Some medications can do the following: • Reduce stomach acid • Overcome spasms of the esophagus • Allow the stomach to empty better CLEVELANDCLINIC.ORG/SWALLOWING SAME-DAY APPOINTMENTS ARE AVAILABLE. CALL 216.444.7000 3 CLEVELAND CLINIC | GUIDE FOR SWALLOWING AND ESOPHAGEAL DISORDERS SURGERY Lifestyle changes can help Surgery also may be an option for people with swallowing disorders. Surgical treatments depend on the location of the swallowing disorder and may involve strengthening or loosening the esophageal sphincters or removing scar tissue and/or Lifestyle changes may control your tumors from the esophagus. symptoms and help reduce your risk of complications from GERD. Choose from a variety of healthy foods, but keep a food diary to What is esophagitis? discover what foods trigger your Esophagitis is a general term for any inflammation of the lining of the esophagus. It reflux or heartburn. Common can be caused by leakage of stomach acid into the esophagus (known as gastroesoph- triggers include: ageal reflux disease, or GERD), vomiting, medications such as aspirin, and viruses, fungi, bacteria or diseases the weaken the immune system. • Citrus juices or fruits Symptoms include difficult and/or painful swallowing, heartburn and acid regurgitation. • Spicy foods, garlic and onion • Mint flavoring • Chocolate How is esophagitis diagnosed? • Alcohol Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These • Drinks with caffeine or include: carbonation • Endoscopy – This test uses a long, flexible lighted tube with a camera called an • Tobacco endoscope to look at the esophagus. • Fatty and fried food • Biopsy – During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope. • Tomato-based foods, like spaghetti sauce, chili and pizza • Barium X-ray – During this procedure, X-rays are taken of the esophagus after the patient drinks a barium solution. Barium coats the lining of the esophagus Eat smaller meals and avoid lying and shows up white on an X-ray. This characteristic enables doctors to view down for at least three hours after any abnormalities. eating. You also can sleep
Load more

Recommended publications
  • THE DIGESTIVE SYSTEM: Introduction and Upper GI
    THE DIGESTIVE SYSTEM: Introduction and upper GI Dalay Olson Ph.D Office: Jackson Hall 3-120 Office hours: Monday 2-3pm INTRODUCTION TO GI LEARNING OBJECTIVES 3 Distinguish between the wall layers of the esophagus and those classically represented by the small intestine. ESOPHAGUS STRUCTURE UPPER THIRD ESOPHAGUS STRUCTURE LOWER TWO-THIRDS 4 Describe the voluntary and reflex components of swallowing. PHASES OF SWALLOWING Swallowing is integrated in the medulla oblongata. Voluntary Phase Pharyngeal Phase Esophageal Phase The swallowing reflex requires input from sensory afferent nerves, somatic motor nerves and autonomic nerves. VOLUNTARY PHASE The tongue pushes the bolus of food back and upwards towards the back of the mouth. Once the food touches the soft palate and the back of the mouth it triggers the swallowing reflex. This is the stimulus! PHARYNGEAL PHASE • Once the food touches the soft palate and the back of the mouth it triggers the swallowing reflex. This is the stimulus! • The medulla oblongata (control center) then initiates the swallowing reflex causing the soft palate to elevate, closing of the glottis and opening of the esophageal sphincter (response). • Once the food moves into the esophagus the sphincter closes once again. The glottis then opens again and breathing resumes. ESOPHAGEAL PHASE 1. Food moves along the esophagus by peristalsis (waves of smooth muscle contractions) • If the food gets stuck, short reflexes will continue peristalsis. • Myogenic reflex (you will learn about this later) produces contractions that move food forward. 2. As the bolus of food moves toward the stomach the lower esophageal sphincter relaxes and opens allowing the food to move into the stomach.
    [Show full text]
  • Fecal Incontinence/Anal Incontinence
    Fecal Incontinence/Anal Incontinence What are Fecal incontinence/ Anal Incontinence? Fecal incontinence is inability to control solid or liquid stool. Anal incontinence is the inability to control gas and mucous in addition to the inability to control stool. The symptoms range from mild release of gas to a complete loss of control. It is a common problem affecting 1 out of 13 women under the age of 60 and 1 out of 7 women over the age of 60. Men can also be have this condition. Anal incontinence is a distressing condition that can interfere with the ability to work, do daily activities and enjoy social events. Even though anal incontinence is a common condition, people are uncomfortable discussing this problem with family, friends, or doctors. They often suffer in silence, not knowing that help is available. Normal anatomy The anal sphincters and puborectalis are the primary muscles responsible for continence. There are two sphincters: the internal anal sphincter, and the external anal sphincter. The internal sphincter is responsible for 85% of the resting muscle tone and is involuntary. This means, that you do not have control over this muscle. The external sphincter is responsible for 15% of your muscle tone and is voluntary, meaning you have control over it. Squeezing the puborectalis muscle and external anal sphincter together closes the anal canal. Squeezing these muscles can help prevent leakage. Puborectalis Muscle Internal Sphincter External Sphincter Michigan Bowel Control Program - 1 - Causes There are many causes of anal incontinence. They include: Injury or weakness of the sphincter muscles. Injury or weakening of one of both of the sphincter muscles is the most common cause of anal incontinence.
    [Show full text]
  • Mixing Alcohol with Your Diabetes You Can Drink If Your Blood Sugar Is Well Controlled – and You Take the Right Steps to Be Safe
    Diabetes Education – #16 Mixing Alcohol with Your Diabetes You can drink if your blood sugar is well controlled – and you take the right steps to be safe. If you have diabetes, you may think that drinking is off limits. Not so! Keeping an eye on how much and what you drink can help you drink more safely. You can avoid the alcohol-related pitfalls: • low blood sugar • weight gain • high blood pressure. Before you have a drink, ask yourself the 3 questions below. The ADA (American Diabetes Association) suggests these: • Is my diabetes in good control? • Does my health care team agree that I can have alcohol? • Do I know how alcohol can affect me and my blood sugar? If you can answer "yes" to all 3 questions, it is likely OK to have a drink. But make sure you know the potential effects of drinking. And, make sure you know your personal limits. What happens when you drink? Between meals and while you sleep, the liver makes new glucose (sugar). The liver then sends this sugar into the bloodstream. Here, it helps to prevent or slow down a low blood sugar reaction. When you drink, it disrupts the process. Substances form when alcohol breaks down in the liver. These substances block the liver from making new glucose. Blood sugars fall and you can quickly become too low. Diabetes Education – #16 Treat hypoglycemia quickly Drinking can affect your blood sugar for up to 12 hours. So test your blood sugar before going to bed. If it is in the 100 – 140 mg/dL range, you may be fine.
    [Show full text]
  • Lung Anatomy
    Lung anatomy Breathing Breathing is an automatic and usually subconscious process which is controlled by the brain. The brain will determine how much oxygen we require and how fast we need to breathe in order to supply our vital organs (brain, heart, kidneys, liver, stomach and bowel), as well as our muscles and joints, with enough oxygen to carry out our normal daily activities. In order for breathing to be effective we need to use our lungs, breathing muscles and blood system efficiently. This leaflet should help you to better understand the process of breathing and how we get the much needed oxygen into our bodies. The lungs You have two lungs, one in the right side and one in the left side of your chest. The right lung is bigger than the left due to the position of the heart (which is positioned in the left side of the chest). Source: Pulmonary Rehabilitation Reference No: 66354-1 Issue date: 13/2/20 Review date: 13/2/23 Page 1 of 5 Both lungs are covered by 2 thin layers of tissue called the pleura. The pleura stop the surface of the lungs rubbing together as we breathe in and out. The lungs are protected by the ribcage. The airways Within the lungs there is a vast network of airways (tubes) which help to transport the oxygen into the lungs and the carbon dioxide out. These tubes branch into smaller and smaller tubes the further they go into the lungs. Page 2 of 5 Trachea (windpipe): This tube connects your nose and mouth to your lungs.
    [Show full text]
  • Obstructive Sleep Apnea
    ObSTruCTIve Sleep ApneA provider’s guide to diagnose and code sleep apnea Sleep apnea is a common disorder that by When reviewing these symptoms it is helpful definition is characterized by a reduction in to clarify the history with the patient’s sleeping normal breathing during hours of sleep, often partner, when available. The most useful symptom related to the collapse of the soft tissues in the for identifying patients with OSA is nocturnal back of the throat. Obstructive sleep apnea (OSA) choking or gasping. Snoring alone is not a is the most common sleeping disorder. It has been diagnostic predictor for OSA. However, the lack diagnosed in 3 to 7% of Americans. It is estimated of snoring and/or presence of apnea reduce the that 20% of the entire American population has not likelihood of an OSA diagnosis. been diagnosed. Quantification of the patient’s perception Independent risk factors for of daytime sleepiness and/or fatigue is an important historical finding. This can be developing OSA include: determined by using the Epworth Sleepiness › Obesity (BMI > 30 kg/m2) Scale (epworthsleepinessscale.com). A score of 10 supports the hypothesis of excessive daytime › African – American race sleepiness, which should prompt the clinician to › Male gender have the patient tested for OSA. › Advancing age › Cranio – facial anomalies The physical examination should focus on: Smoking › 1. Review of the oral airway, specifically: › Controlled substance use and alcohol intake the size of the uvula and tonsils, and › Chronic medical conditions such as: the presence of nasal septal deviation end-stage renal disease, congestive heart failure, 2.
    [Show full text]
  • PYLORIC STENOSIS of INFANCY-PERSPECTIVES Different Views from Different Bridges
    Central Annals of Pediatrics & Child Health Perspective *Corresponding author IAN M. ROGERS, Department of Surgery, AIMST University, 46 Whitburn Road, Cleadon, Tyne and Wear, SR67QS, Kedah, Malaysia, Tel: 01915367944; PYLORIC STENOSIS OF INFANCY- 07772967160; Email: [email protected] Submitted: 18 March 2020 PERSPECTIVES Different views Accepted: 27 March 2020 Published: 30 March 2020 ISSN: 2373-9312 from different bridges Copyright © 2020 ROGERS IM IAN M ROGERS* OPEN ACCESS Department of Surgery, AIMST University, Malaysia Keywords Abstract • Neonatal hyperacidity; Neonatal hypergastrinaemia; Baby and parents perspectives of diagnosis Introduction: The differing experiences of the surgeon, he parent and the baby and treatment; Spectrum of presentation of are discussed in terms of what is presently known about the pathogenesis of pyloric pyloric stenosis of infancy; Primary hyperacidity stenosis of infancy (PS). pathogenesis of pyloric stenosis Methods: The experiences are culled from personal experience and from the comments made on online pressure and support groups for pyloric stenosis of infancy. These comments are reviewed from the standpoint of the Primary Hyperacidity pathogenesis of cause. Conclusion: The present perspectives of the PS surgeon and the difficulties experienced by the PS family fit well which the basic tenets of the Primary Hyperacidity theory. Reference to this theory allows a satisfactory explanation for difficulties in diagnosis and for the variability of presentation. INTRODUCTION In 1961 this theme was further developed by Dr Jacob. He again recognised the milder forms-those in which a long- term The Surgeon cure could similarly be achieved without surgery. A 1% mortality Everybody knows: For progressive pyloric stenosis of infancy in 100 patients was achieved with the usual medical measures (PS), pyloromyotomy reigns supreme! Impending catastrophe of which a reduced feeding regime was judged to be especially transformed safely, in a few minutes, into an enduring cure.
    [Show full text]
  • Mouth Esophagus Stomach Rectum and Anus Large Intestine Small
    1 Liver The liver produces bile, which aids in digestion of fats through a dissolving process known as emulsification. In this process, bile secreted into the small intestine 4 combines with large drops of liquid fat to form Healthy tiny molecular-sized spheres. Within these spheres (micelles), pancreatic enzymes can break down fat (triglycerides) into free fatty acids. Pancreas Digestion The pancreas not only regulates blood glucose 2 levels through production of insulin, but it also manufactures enzymes necessary to break complex The digestive system consists of a long tube (alimen- 5 carbohydrates down into simple sugars (sucrases), tary canal) that varies in shape and purpose as it winds proteins into individual amino acids (proteases), and its way through the body from the mouth to the anus fats into free fatty acids (lipase). These enzymes are (see diagram). The size and shape of the digestive tract secreted into the small intestine. varies in each individual (e.g., age, size, gender, and disease state). The upper part of the GI tract includes the mouth, throat (pharynx), esophagus, and stomach. The lower Gallbladder part includes the small intestine, large intestine, The gallbladder stores bile produced in the liver appendix, and rectum. While not part of the alimentary 6 and releases it into the duodenum in varying canal, the liver, pancreas, and gallbladder are all organs concentrations. that are vital to healthy digestion. 3 Small Intestine Mouth Within the small intestine, millions of tiny finger-like When food enters the mouth, chewing breaks it 4 protrusions called villi, which are covered in hair-like down and mixes it with saliva, thus beginning the first 5 protrusions called microvilli, aid in absorption of of many steps in the digestive process.
    [Show full text]
  • Hemoptysis in Children
    R E V I E W A R T I C L E Hemoptysis in Children G S GAUDE From Department of Pulmonary Medicine, JN Medical College, Belgaum, Karnataka, India. Correspondence to: Dr G S Gaude, Professor and Head, Department of Pulmonary Medicine, J N Medical College, Belgaum 590 010, Karnataka, India. [email protected] Received: November, 11, 2008; Initial review: May, 8, 2009; Accepted: July 27, 2009. Context: Pulmonary hemorrhage and hemoptysis are uncommon in childhood, and the frequency with which they are encountered by the pediatrician depends largely on the special interests of the center to which the child is referred. Diagnosis and management of hemoptysis in this age group requires knowledge and skill in the causes and management of this infrequently occurring potentially life-threatening condition. Evidence acquisition: We reviewed the causes and treatment options for hemoptysis in the pediatric patient using Medline and Pubmed. Results: A focused physical examination can lead to the diagnosis of hemoptysis in most of the cases. In children, lower respiratory tract infection and foreign body aspiration are common causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography. The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with close monitoring. Massive hemoptysis may require additional therapeutic options such as therapeutic bronchoscopy, angiography with embolization, and surgical intervention such as resection or revascularization. Conclusions: Hemoptysis in the pediatric patient requires prompt and thorough evaluation and treatment.
    [Show full text]
  • IDP Biological Systems Gastrointestinal System
    IDP Biological Systems Gastrointestinal System Section Coordinator: Jerome W. Breslin, PhD, Assistant Professor of Physiology, MEB 7208, 504-568-2669, [email protected] Overall Learning Objectives 1. Characterize the important anatomical features of the GI system in relation to GI function. 2. Describe the molecular and cellular mechanisms underlying GI motility. Highlight the neural and endocrine regulatory mechanisms. Characterize the different types of GI motility in different segments of the GI tract. 3. Define the major characteristics and temporally relate the cephalic, gastric, and intestinal phases of GI tract regulation. 4. For carbohydrates, proteins, fats, vitamins, minerals, and oral drugs, differentiate the processes of ingestion, digestion, absorption, secretion, and excretion, including the location in the GI tract where each process occurs. 5. Contrast the sympathetic and parasympathetic modulation of the enteric nervous system and the effector organs of the GI tract. 6. Describe the similarities and differences in regulating gastrointestinal function by nerves, hormones, and paracrine regulators. Include receptors, proximity, and local vs. global specificity. 7. Understand the basic mechanisms underlying several common GI disorders and related treatment strategies. Learning Objectives for Specific Hours: Hour 1 – Essential Concepts: Cellular transport mechanisms and Mechanisms of Force Generation 1. Describe the composition of cell membranes and how distribution of phospholipids and proteins influence membrane permeability of ions, hydrophilic, and hydrophobic compounds. 2. Using a cell membrane as an example, define a reflection coefficient, and explain how the relative permeability of a cell to water and solutes will generate osmotic pressure. Contrast the osmotic pressure generated across a cell membrane by a solution of particles that freely cross the membrane with that of a solution with the same osmolality, but particles that cannot cross the cell membrane.
    [Show full text]
  • Managing a High Output Ostomy: for Patients with an Ileostomy Or Jejunostomy
    Form: D-8844 Managing a High Output Ostomy: For patients with an ileostomy or jejunostomy Read this brochure to learn: • what is a high output ostomy • why is a high output ostomy a problem • what foods and drinks can help you manage it What is a high output ostomy? A high output ostomy is when your ostomy output (the amount of waste coming out of your stoma) is more than 1.2 litres (about 5 cups) in a day. Signs of a high output ostomy include: • having to empty your stoma bag more than 8 times a day • having watery output Why is it a problem? You may become dehydrated (your body does not get enough water) if you have too much output. Your body may not absorb fluids well when you have a high output ostomy. Signs of dehydration are: • feeling thirsty • peeing less than usual • having dark yellow pee • losing weight • having dry lips and mouth • having a headache, dizziness or fatigue 2 How can I manage a high output ostomy? Making some changes to how you eat and drink can help manage a high output ostomy. Your health care team may also give you medicine to help manage a high output ostomy. 9 Have a small meal every 2 to 3 hours. This helps your body absorb food better and meet your nutrition needs. 9 Chew your food very well. This makes it easier for your body to break down and use the food you eat. 9 Do not drink fluids while you eat. Wait 30 minutes before and after a meal before drinking fluids.
    [Show full text]
  • Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent
    Abe et al. J Clin Gastroenterol Treat 2016, 2:038 Volume 2 | Issue 4 Journal of ISSN: 2469-584X Clinical Gastroenterology and Treatment Clinical Image: Open Access Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent Takashi Abe1, Takayuki Nagai1 and Kazunari Murakami2 1Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Japan 2Department of Gastroenterology, Oita University, Japan *Corresponding author: Takashi Abe M.D., Ph.D., Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Tsurumi 4333, Beppu City, Oita 874-8585, Japan, Tel: +81-977-23-7111 Fax: +81-977-23-7884, E-mail: [email protected] Keywords Esophagus, Pulmonary parenchyma, Fistula, lung cancer, Self- expandable metallic stent A 71-year-old man was diagnosed with squamous cell lung cancer in the right lower lobe. He was treated with chemotherapy (first line: TS-1/CDDP; second line: carboplatin/nab-paclitaxel) and radiation therapy (41.4 Gy), but his disease continued to progress. The patient complained of relatively sudden-onset chest pain and high-grade fever. Computed tomography (CT) showed a small volume of air in the lung cancer of the right lower lobe, so the patient was suspected of fistula between the esophagus and the lung parenchyma. Upper gastrointestinal endoscopy revealed an esophageal fistula (Figure 1), which esophagography using water- soluble contrast medium showed overlying the right lower lobe Figure 2: Esophagography findings. Contrast medium is shown overlying the right lower lobe (arrow). (Figure 2). The distance from the incisor teeth to this fistula was 28 cm endoscopically. CT, which was done after esophagography, showed fistulous communication between the esophagus and Figure 1: Endoscopy showing esophageal fistula (arrow).
    [Show full text]
  • Abdominal Pain - Gastroesophageal Reflux Disease
    ACS/ASE Medical Student Core Curriculum Abdominal Pain - Gastroesophageal Reflux Disease ABDOMINAL PAIN - GASTROESOPHAGEAL REFLUX DISEASE Epidemiology and Pathophysiology Gastroesophageal reflux disease (GERD) is one of the most commonly encountered benign foregut disorders. Approximately 20-40% of adults in the United States experience chronic GERD symptoms, and these rates are rising rapidly. GERD is the most common gastrointestinal-related disorder that is managed in outpatient primary care clinics. GERD is defined as a condition which develops when stomach contents reflux into the esophagus causing bothersome symptoms and/or complications. Mechanical failure of the antireflux mechanism is considered the cause of GERD. Mechanical failure can be secondary to functional defects of the lower esophageal sphincter or anatomic defects that result from a hiatal or paraesophageal hernia. These defects can include widening of the diaphragmatic hiatus, disturbance of the angle of His, loss of the gastroesophageal flap valve, displacement of lower esophageal sphincter into the chest, and/or failure of the phrenoesophageal membrane. Symptoms, however, can be accentuated by a variety of factors including dietary habits, eating behaviors, obesity, pregnancy, medications, delayed gastric emptying, altered esophageal mucosal resistance, and/or impaired esophageal clearance. Signs and Symptoms Typical GERD symptoms include heartburn, regurgitation, dysphagia, excessive eructation, and epigastric pain. Patients can also present with extra-esophageal symptoms including cough, hoarse voice, sore throat, and/or globus. GERD can present with a wide spectrum of disease severity ranging from mild, intermittent symptoms to severe, daily symptoms with associated esophageal and/or airway damage. For example, severe GERD can contribute to shortness of breath, worsening asthma, and/or recurrent aspiration pneumonia.
    [Show full text]