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Management of uncomplicated GORD Lifestyle modification Patients are recommended to have a healthy diet, avoid over eating and avoid dietary items (e.g. carbonated drinks, alcohol, tea or co ff ee) or activities that in the patient’s experience would provoke the...

Management In stable patients with a clear history and contained perfo ration, sometimes conservative expectant treatment can be successful. This usually applies to cervical/pharyngeal perfo ration when patients are much less septic. Antibiotics should be give...

Manometric classification Oesophageal motility disorders are classified on HRM under the Chicago classification. A hierarchy diagnostic algorithm is utilised ( Figure 66.23 ). Broadly speaking, these disorders can be classified as disorders of OGJ outflow and diso...

Multimodality treatment strategies Results from surgical resection alone have improved. Mortality from surgery is less than 5% in dedicated centres. The long term prognosis remains suboptimal. Since the 1990s, multi- modality treatment has gained impetus and i...

NEOPLASMS OF THE OESOPHAGUS

OESOPHAGEAL DISEASES Radiography As a posterior mediastinal structure, the oesophagus is normally - obscured on plain radiographs by other structures such as the - spine, major vessels, airway and heart. However, this simple imaging test often gives clues of ...

OESOPHAGEAL INVOL VEMENT IN SYSTEMIC DISEASE The oesophagus can be a ff ected by a variety of systemic diseases; examples include systemic sclerosis/scleroderma, polymyositis, dermatomyositis, systemic lupus erythematosus and polyarteritis nodosa. Scleroderma m...

OESOPHAGEAL PERFORATION Oesophageal perforation is associated with high morbidity and mortality rates. It is an emergency and prompt treatment should be instituted because delayed diagnosis and treatment are associated with a marked increase in mortality rate....

OESOPHAGEAL ULCERATION/ INFECTIONS GORD is the most common cause of oesophageal ulceration but there are a variety of other reasons, including iatrogenic related to endoscopic procedures, the presence of a naso - gastric tube and medications such as tetracyc...

Oesophageal manometry Manometry is used to diagnose oesophageal motility disorders and to assess the oesophageal body and LOS function before surgery , such as antireflux operations. Conventional manome try was developed in the 1950s with water-perfused cathete...

Oesophageal varices Oesophageal varices usually present with sudden, large-volume haematemesis secondary to portal hypertension, which is most commonly due to hepatic cirrhosis. Details of presentation and management can be found in Chapter 69 .

Other oesophageal motility disorders Hypercontractile motility disorders Distal oesophageal spasm is a condition in which there are incoordinate, premature and rapidly propagated contractions of the oesophagus, causing dysphagia and/or chest pain. The conditi...

Palliation In the presence of distant metastases, palliation is the aim. Dysphagia is the main symptom to relieve. Placement of a self-expanding metallic stent is simple and e ff ective and allows immediate relief of dysphagia ( Figure 66.57 ). The risks ar...

Pharyngeal and oesophageal diverticula Oesophageal diverticula can be classified as true diverticula, which involve a full-thickness oesophageal wall, and false diverticula, which involve mucosal outpouching only . Diver ticula are usually described by their lo...

Presentation and diagnosis Sometimes the history is obvious, such as after instrumenta - - tion or foreign body ingestion. At other times there may not have been any precipitating cause. Patients with Boerhaave’s syndrome may have the classic triad of vomitin...

Screening and surveillance The risk factors for Barrett’s oesophagus and related neoplasm include chronic (>5 years) GORD symptoms, advanced age (>50 years), smoking, central obesity and male gender. For non-dysplastic Barrett’s, the risk of progression to can...

Surgical management While most patients’ symptoms are satisfactorily controlled with PPIs and other medications, surgery remains an import ant option. The indications for surgery include (i) incomplete symptom control with medical management, (ii) intolerance ...

Treatment When Barrett’s oesophagus is discovered, the treatment is that of the underlying GORD. Pharmacological therapy generally is the same as treatment of symptomatic GORD patients. Antireflux surgery is indicated if it is associated with GORD symptoms. ...