Main description:

This book aims to be a synthesis of our current knowledge about the normal and pathological esophagus. Although a number of excellent monographs on limited aspects of esophageal pathology are available, a recent handbook treating the whole of esophageal physiology and pathology is lacking. We attempted to present the collected material in such a way that even the neophyte in the field would not get lost in the wealth of data. For this reason we have included a number of illustrations such as classical radiological and endoscopic images, manometric tracings and uncomplicated graphs, which may seem superfluous for specialists but will be helpful to the reader who wants to be initiated in the subject. At the same time we tried to be fairly complete so as to make available to the esophageal specialist a book of references, to which he can readily turn when faced with rare diseases or unusual physiological or pathophysiological pheno mena. In order to achieve both aims the authors often give their own point of view when faced with controversal topics, while classical as well as more recent features and concepts are mentioned and diverging opinions discussed.

Contents:

1 Basic Data.- Anatomy and Embryology.- 1. Anatomy.- 1.1. Topographic Anatomy.- 1.1.1. The Cervical Esophagus.- 1.1.2. The Thoracic Esophagus.- 1.1.3. The Abdominal Esophagus.- 1.2. The Musculature of the Esophagus Proper.- 1.3. The Pharyngoesophageal Junction.- 1.4. The Esophagogastric Junction.- 1.4.1. The Gastroesophageal Sphincter.- 1.4.2. The Phrenoesophageal Membrane.- 1.4.3. The Diaphragmatic Hiatus.- 1.5. Arterial Blood Supply.- 1.6. Venous Drainage.- 1.6.1. Intrinsic Veins.- 1.6.2. Extrinsic Veins.- 1.7. Lymphatic Drainage.- 1.8. Nerve Supply (Innervation).- 1.8.1. Parasympathetic Innervation.- 1.8.2. Sympathetic Innervation.- 2. Embryology.- References.- Histology and Electron Microscopy.- 1. Mucous Membrane (Tunica Mucosa).- 1.1. Epithelium.- 1.1.1. Squamous Epithelium.- 1.1.1.1. Histology.- 1.1.1.2. Cell Kinetics.- 1.1.1.3. Histochemistry.- 1.1.1.4. Electron Microscopy.- 1.1.2. Non-squamous Epithelial Structures, Cardia-type Glands.- 1.1.2.1. Histology.- 1.1.2.2. Electron Microscopy.- 1.2. Lamina Propria.- 1.3. Muscularis Mucosae.- 2. Tunica Submucosa.- 3. Tunica Muscularis.- 4. Angio-architecture.- 5. Innervation.- 6. Adventitia, Elastic-muscular System, Serosa.- References.- Physiology.- 1. The Functions of the Esophagus.- 2. The Esophagus at Rest.- 2.1. The Pharyngoesophageal Sphincter.- 2.1.1. Location.- 2.1.2. The Pressure Profile of the Pharyngoesophageal Sphincter.- 2.1.3. Manometric Measurements of the Resting Pressure in the Pharyngoesophageal Sphincter.- 2.1.4. Respiratory Pressure Variations.- 2.1.5. Elasticity or Tonic Contraction.- 2.2. The Esophagus Proper.- 2.2.1. The Resting Pressure.- 2.3. The Lower Esophageal Sphincter (L.E.S.) (Gastroesophageal Sphincter).- 2.3.1. The Position of the Sphincter in Relation to the Squamocolumnar Junction.- 2.3.2. The Pressure Profile of the Sphincter. The Pressure Inversion Point (P.I.P.).- 2.3.3. Manometric Measurements of the Resting Pressure in the Lower Esophageal Sphincter.- 2.3.4. Other Measurements of Sphincter Strength.- 2.3.5. Variations of the Sphincteric Pressure.- 2.3.5.1. The Intrinsic Sphincteric Properties.- 2.3.5.2. Hormonal Control of the Sphincter Strength.- 2.3.5.3. The Response of the Lower Esophageal Sphincter to Increased Intragastric Pressure.- 2.3.5.4. Nervous Control of the Lower Esophageal Sphincter Pressure.- 3. Bolus Transport. Primary Peristalsis.- 3.1. Mechanical Activity.- 3.1.1. Oral Transport.- 3.1.2. Pharyngeal Transport.- 3.1.3. Electromyographic Studies of Deglutition.- 3.1.3.1. Leading Complex.- 3.1.3.2. Constrictor Musculature.- 3.1.3.3. Variations in Ancillary Activity.- 3.1.4. Esophageal Transport.- 3.1.4.1. The Peristaltic Progression.- 3.1.4.2. Longitudinal and Circular Musculature.- 3.1.4.3. Striated and Smooth Muscles.- 3.1.5. Transport through the Gastroesophageal Sphincter.- 3.2. Intraluminal Pressure Variations.- 3.2.1. The Deglutition Complex in the Pharynx and in the Pharyngoesophageal Sphincter.- 3.2.1.1. Relaxion of the High Pressure Zone.- 3.2.1.2. The e-(Elevation) Wave.- 3.2.1.3. The t-(Tongue) Wave.- 3.2.1.4. The p-(Peristaltic) Wave.- 3.2.2. The Deglutition Complex in the Esophagus.- 3.2.2.1. The Initial Negative Deflexion.- 3.2.2.2. The First Positive Wave.- 3.2.2.3. The Second Positive Wave.- 3.2.2.4. The Peristaltic Contraction.- 3.2.3. The Deglutition Complex in the Gastroesophageal Sphincter.- 3.3. Innervation.- 3.3.1. Innervation of Oropharyngeal Phase.- 3.3.1.1. The Deglutition Center in the Rhombencephalon.- 3.3.1.2. The Peripheral Afferent System.- 3.3.1.3. Elementary Reflexes Versus Swallowing.- 3.3.1.4. The Central Afferent System.- 3.3.1.5. The Cortical Control of the Deglutition Center.- 3.3.1.6. Interference with Other Centers.- 3.3.1.7. Efferent Pathways. Motoneurons.- 3.3.2. Innervation of the Esophageal Phase.- 3.3.2.1. Central Nervous Centers.- 3.3.2.2. Afferent Pathways.- 3.3.2.3. Efferent Pathways.- 3.3.2.4. The Intramural Nervous System.- 4. Reflex Responses of the Esophagus.- 4.1. Secondary Peristalsis.- 4.2. Esophageal Propulsive Force (E.P.F.).- 4.3. On-and off-Response; Duration Response.- 4.3.1. The "On" Response (Circular Muscle).- 4.3.2. The "Off" Response (Circular Muscle).- 4.3.3. The Duration Response (Longitudinal Muscle).- 4.4. Inhibition.- 4.4.1. Deglutitive Inhibition.- 4.4.2. Inhibition by Distension.- 4.5. Relaxion of the Gastroesophageal Sphincter.- 4.6. Other Reflexes.- 5. Retrograde Transport.- 5.1. Rumination-Eructation.- 5.2. Retching and Vomiting.- 5.3. Belching.- References.- 2 Diagnostic Procedures.- History and Symptoms of Esophageal Disease.- 1. Symptoms and Syndromes.- 1.1. Symptoms and their Significance.- 1.1.1. The Sensation of Obstruction.- 1.1.1.1. The Site of the Obstruction.- 1.1.1.2. The Site of the Receptors.- 1.1.1.3. The Sensation of "Choking".- 1.1.2. Regurgitation.- 1.1.2.1. The Volume of Regurgitate.- 1.1.2.2. The Taste.- 1.1.2.3. The Content.- 1.1.2.4. The Timing.- 1.1.2.5. The Association with Position.- 1.1.3. Pain.- 1.1.3.1. The Distribution.- 1.1.3.2. The Character.- 1.1.3.3. The Timing.- 1.2. Syndromes.- 1.2.1. "Spill-Over" and "Spill-Into" Disease.- 1.2.2. Obstruction Syndromes.- 1.2.2.1. The Stricture Syndrome.- 1.2.2.2. The Achalasia Syndrome.- 1.2.3. The So-Called "Functional" Dysphagias.- 2. History.- 2.1. Pharyngeal Problems.- 2.1.1. Pouch.- 2.1.2. Stricture or Web.- 2.1.3. Muscular and Neural.- 2.2. Esophageal Problems.- Radiological Examination of the Esophagus.- 1. The Radiological Technique.- 1.1. Equipment.- 1.1.1. The Standard Diagnostic X-Ray Unit.- 1.1.2. The Image Intensifier.- 1.1.3. Television Fluoroscopy.- 1.1.4. Spot Filming.- 1.2. The Recording Techniques Used with Image Intensifiers.- 1.2.1. Photofluorography.- 1.2.2. Cinefluorography.- 1.3. Techniques of Recording the Television Images.- 1.3.1. Cinefluorography.- 1.3.2. Video Recording.- 2. Contrast Materials.- 2.1. Positive Contrast Materials.- 2.1.1. Barium Sulfate.- 2.1.2. Iodinated Contrast Materials.- 2.1.3. Tantalum Powder.- 2.2. Negative Contrast Materials.- 3. The Radiological Examination.- 3.1. General Principles.- 3.2. Normal Radiological Anatomy and Physiology.- 3.2.1. Hypopharynx and Cervical Esophagus.- 3.2.1.1. Radiological Landmarks.- 3.2.1.2. Hypopharynx and Cervical Esophagus during Swallowing.- 3.2.1.3. Hypopharynx and Cervical Esophagus after Swallowing.- 3.2.1.4. The Modified Valsalva Maneuver.- 3.2.2. Thoracic Esophagus.- 3.2.2.1. Normal Motor Activity.- 3.2.2.2. Normal Esophagogram.- 3.2.3. Esophagogastric Region.- 3.3. Preparation of the Patient.- 3.4. Radiological Examination without Contrast Material.- 3.4.1. The Air Esophagogram.- 3.4.2. Mediastinal Widening.- 3.4.3. Mediastinal Calcifications.- 3.4.4. Signs Related to Esophageal Perforation or Rupture.- 3.4.5. Retention of Contrast Material.- 3.5. Radiological Examination with Contrast Material.- 3.5.1. Basic Technique of Examination.- 3.5.2. Abnormal Images.- 3.5.2.1. Filling Defects and Impressions.- 3.5.2.2. Narrowings.- 3.5.2.3. Changes in Mucosal Pattern.- 3.5.2.4. Crater-like Images.- 3.5.2.5. Diverticula, Perforations, Fistulas.- 3.6. Special Procedures.- 3.6.1. Examination of the Pharyngoesophageal Region.- 3.6.1.1. Examination without Contrast Material.- 3.6.1.2. Examination with Contrast Material.- 3.6.1.3. Abnormal Images of the Opacified Pharyngoesophageal Region.- 3.6.2. The Demonstration of Esophageal Varices.- 3.6.3. Pharmacoradiography.- 4. The Radiological Examination of the Esophagus in Children.- References.- Esophagoscopy.- 1. Introduction.- 2. Common Recommendations for All Endoscopic Examinations.- 3. Equipment and Techniques.- 3.1. Rigid Esophagoscopy.- 3.1.1. The Esophagoscope of Segal and Dubois de Montreynaud.- 3.1.2. The Eder-Hufford Esophagoscope.- 3.1.3. Results of Rigid Esophagoscopy.- 3.2. Flexible Esophagoscopy.- 3.2.1. Principle of the Fiberscopes.- 3.2.2. Instruments.- 3.2.3. Examination Technique.- 3.2.3.1. Preparation and Positioning of the Patient.- 3.2.3.2. Insertion of the Apparatus and Exploration.- 3.2.3.3. Associate Maneuvers.- 3.2.3.4. Advantages and Drawbacks.- 4. Indications and Contraindications.- 5. Accidents and Incidents.- 5.1. Accidents.- 5.1.1. Perforation.- 5.1.2. Hemorrhage.- 5.2. Incidents.- 5.2.1. Failure to Pass Pharyngoesophageal Sphincter.- 5.2.2. Respiratory Spasm.- 5.2.3. Pain.- 5.2.4. Bleeding.- References.- Exfoliative Cytology of the Esophagus.- 1. Introduction.- 2. Esophageal Cytological Techniques.- 2.1. Techniques Combined with Esophagoscopy.- 2.2. Abrasive Techniques.- 2.3. Lavage Techniques.- 2.4. Combined Techniques.- 3. An Appraisal of Cytologic Techniques.- 4. Normal Cytology of the Esophagus.- 5. Criteria for Malignancy in Esophageal Cytology.- 6. Cyto-Histological Correlations.- 7. Indications of Esophageal Cytology.- 8. Results of Esophageal Cytology.- 9. Diagnostic Errors.- 10. Cytology Compared with Other Diagnostic Techniques.- 11. Fluorescent Techniques in Esophageal Cytology.- 12. Cytology in Beningn Conditions of the Esophagus.- 13. Effects of Roentgen Therapy on Esophageal Cells.- 14. Cytology in the Early Diagnosis of Esophageal Cancer.- References.- The Manometric Examination of the Esophagus.- 1. The Balloon-Kymographic Method.- 2. Intraluminal Pressure Measurements.- 3. Interpretation of Intraluminal Pressure Measurements.- 4. The Perfused Catheter System.- 5. The Technique of Intraluminal Pressure Measurements.- References.- pH Measurements.- 1. pH Measurements in vitro.- 2. pH Measurements in vivo.- 3. The Pull-trough Technique.- 4. Fixed Location of pH Electrode.- 5. Interpretation of Results.- 6. The Acid Clearing Test.- 7. Protracted pH Measurements.- References.- PD Measurements.- 1. History.- 2. The Origin of the Potential Difference.- 3. Techniques of PD Measurements.- 4. PD Measurements in the Esophagus.- References.- The Acid Infusion Test.- 1. Procedure.- 2. Hazards of the Test.- 3. The Mechanism of Pain.- References.- Pharmacological Tests.- References.- Electromyography of the Esophagus.- 1. Introduction.- 2. Registration Method.- 3. The Electromyographic Tracings.- 3.1. The Pharyngoesophageal Sphincter.- 3.2. The Striated Muscle Segment of the Esophagus.- 3.3. The Transitional Zone between Striated and Smooth Muscles.- 3.4. The Smooth Muscle Segment of the Esophagus.- 3.5. The Gastroesophageal Sphincter.- 4. The Deglutitive Inhibition.- 5. Electromyography in Esophageal Diseases.- References.- 3 Motility Disturbances of the Esophagus.- Achalasia.- 1. Definition.- 2. Incidence.- 2.1. Age Distribution.- 2.2. Sex Distribution.- 2.3. Geographical Distribution and Incidence.- 3. Achalasia in Animals.- 4. Etiology and Pathogenesis.- 4.1. Genetic Factors.- 4.2. Neuromuscular Abnormalities.- 4.2.1. Anatomical Lesions.- 4.2.1.1. The Nuclei of the Brainstem.- 4.2.1.2. Vagal Nerve Fibres.- 4.2.1.3. The Intramural Nerve Plexus.- 4.2.1.4. Smooth Muscle.- 4.2.2. Pharmacological Defects.- 5. Clinical Features.- 5.1. Symptoms and Signs.- 5.2. Vigorous Achalasia.- 6. Technical Examinations.- 6.1. Radiology.- 6.1.1. Plain Chest Film.- 6.1.2. Radiological Examination with Contrast Medium.- 6.1.2.1. Minimal Achalasia.- 6.1.2.2. Mild Achalasia.- 6.1.2.3. Moderate Achalasia.- 6.1.2.4. Severe Achalasia.- 6.2. Manometry.- 6.2.1. Resting Pressures in the Gastroesophageal Sphincter.- 6.2.2. Resting Pressure in the Esophagus.- 6.2.3. The Deglutitive Response in the Gastroesophageal Sphincter.- 6.2.4. Deglutitive Responses in the Esophagus.- 6.3. Mecholyl Test.- 6.4. Cytological Examination.- 6.5. Endoscopic Examination.- 7. Differential Diagnosis.- 7.1. Other Causes of Megaesophagus.- 7.1.1. Chagas' Disease.- 7.1.1.1. Acute Phase.- 7.1.1.2. Chronic Chagas' Syndrome.- 7.1.1.3. Megacolon.- 7.1.1.4. Megaesophagus.- 7.1.2. Esophageal Cancer.- 7.1.3. Rare Causes of Esophageal Dilatation.- 7.2. Other Causes of Aperistalsis.- 7.3. Achalasia-like Disorders.- 7.4. Diffuse Spasm.- 7.5. Post-Vagotomy Dysphagia.- 7.6. Differential Diagnosis in Children.- 8. Complications and Associated Diseases.- 8.1. Carcinoma.- 8.1.1. Incidence.- 8.1.2. Age and Sex Distribution.- 8.1.3. Pathology.- 8.1.4. Pathogenesis.- 8.1.5. Signs and Symptoms.- 8.1.6. Treatment.- 8.2. Esophagitis.- 8.3. Bronchopulmonary Complications.- 8.4. Perforation.- 8.5. Associated Conditions.- 9. Natural History.- 10. Treatment.- 10.1. Medical and Psychiatric Therapy.- 10.2. Dilatations.- 10.2.1. Types of Dilators.- 10.2.1.1. Mechanical System.- 10.2.1.2. Hydrostatic System.- 10.2.1.3. Pneumatic System.- 10.2.2. Preventive Measures.- 10.2.3. Results.- 10.2.3.1. Immediate Results.- 10.2.3.2. Immediate Complications.- 10.2.3.3. Late Results.- 10.3. Surgical Treatment.- 10.3.1. Techniques.- 10.3.1.1. Operations Based on the Theory of "Idiopathic Dilatation".- 10.3.1.2. Operations Based on the Theory of Disturbance in Esophageal Innervation.- 10.3.1.3. Operations Aimed at Decreasing the Resistance at the Cardia.- 10.3.1.4. Operations to Replace Part of the Esophagus by Intestine.- 10.3.2. Results and Complications of Heller's Myotomy.- 10.3.2.1. Results.- 10.3.2.2. Complications.- 10.4. Sphincteric Pressures after Treatment.- 10.5. Myotomy or Forceful Dilatation?.- References.- Diffuse Esophageal Spasm.- 1. Definition.- 2. Incidence.- 3. Pathology.- 4. Symptoms.- 5. Technical Examinations.- 5.1. Radiology.- 5.2. Manometric Examinations.- 6. Related Conditions.- 6.1. Idiopathic Muscular Hypertrophy of Lower Esophagus.- 6.2. The Hypertensive Sphincter.- 7. Diagnosis.- 8. Treatment.- 8.1. Medical Treatment.- 8.2. Dilatation.- 8.3. Surgical Treatment.- References.- Post-Vagotomy Dysphagia.- 1. Definition.- 2. Incidence.- 3. Symptoms.- 4. Etiology and Pathogenesis.- 5. Treatment.- References.- Presbyesophagus.- 1. Pharynx.- 2. Esophagus.- 3. Gastroesophageal Sphincter.- 4. Nature of the Lesions.- References.- Esophageal Motility in Neonatal Infants.- 1. Introduction.- 2. Normal Motility.- 2.1. Mouth and Pharynx.- 2.2. Esophagus.- 2.2.1. The Esophagus at Rest.- 2.2.1.1. Pharyngoesophageal Sphincter.- 2.2.1.2. Esophageal Body.- 2.2.1.3. Gastroesophageal Sphincter.- 2.2.2. Deglutition.- 2.2.2.1. Pharyngoesophageal Sphincter.- 2.2.2.2. Esophageal Body.- 2.2.2.3. Gastroesophageal Sphincter.- References.- Motor Disorders Due to Collagen Diseases.- 1. Progressive Systemic Sclerosis.- 1.1. Definition and General Data.- 1.2. Esophageal Involvement in Progressive Systemic Sclerosis.- 1.2.1. Incidence.- 1.2.2. Pathology.- 1.2.3. Radiological Examination.- 1.2.4. Manometric Examination.- 1.2.5. Differential Diagnosis.- 1.2.6. Treatment.- 2. Systemic Lupus Erythematosus.- 3. Polymyositis-Dermatomyositis.- 4. Related Syndromes.- References.- Motor Disorders Due to Muscle Disorders.- 1. Myotonic Dystrophy (Steinert's Disease).- 1.1. Definition and General Data.- 1.2. Esophageal Involvement.- 2. Ocular Myopathy and Oculopharyngeal Myopathy.- 2.1. Definition and General Data.- 2.2. Pharyngoesophageal Involvement.- 3. Myasthenia Gravis.- 3.1. Definition and General Data.- 3.2. Pharyngoesophageal Involvement.- 4. Endocrine Disorders of Muscle.- References.- Motor Disorders Due to Lesions of the Central Nervous System.- 1. Brainstem Lesions.- 2. Poliomyelitis.- 3. Motor Neuron Disease.- 4. Extrapyramidal Disturbances.- 5. Stiff-man Syndrome.- 6. Dysautonomia.- References.- Motor Disorders Due to Peripheral Nerve Lesions.- 1. Motor Disorders Associated with Diabetes.- 2. Motor Disturbances Associated with Alcoholic Neuropathy.- References.- Emotional Disorders of the Esophagus.- 1. Globus Hystericus.- 1.1. Definition and Generalities.- 1.2. Clinical Findings.- 1.3. Diagnosis.- 1.4. Interpretation.- 1.5. Treatment.- 2. Esophageal Belching.- 2.1. Definition.- 2.2. Etiology.- 2.3. Clinical Findings.- 2.4. Pathophysiology.- 2.5. Treatment.- 3. Eructation or Belching.- 3.1. Definition.- 3.2. Mechanism of Eructation.- 3.3. Treatment.- 4. Merycism or Rumination.- 4.1. Merycism in Infants.- 4.1.1. Clinical Data.- 4.1.2. Interpretation.- 4.1.3. Treatment.- 4.2. Merycism in Adults.- 4.2.1. Clinical Data.- 4.2.2. Mechanism.- 4.2.3. Treatment.- References.- The Pathophysiological Basis of Gastroesophageal and Intestinoesophageal Reflux.- 1. The Gastroesophageal Closing Mechanism.- 2. Conditions Associated with Gastroesophageal or Intestinoesophageal Reflux.- 2.1. Sliding Hiatal Hernia.- 2.2. Gastroesophageal Incompetence in the Absence of Demonstrable Hiatal Hernia.- 2.3. Scleroderma with Esophageal Involvement and Related Conditions.- 2.4. Following Myotomy for Achalasia of the Esophagus.- 2.5. Vagotomy.- 2.6. Pregnancy.- 2.7. Gastric Operations.- 2.8. Prolonged Gastric Intubation.- References.- 4 Tumors of the Esophagus.- Benign Tumors and Cysts of the Esophagus.- 1. Classification.- 2. Incidence.- 3. Intramural Tumors and Cysts.- 3.1. Leiomyoma.- 3.1.1. Age and Sex Incidence.- 3.1.2. Pathology.- 3.1.3. Symptoms.- 3.1.4. Radiographic Signs.- 3.1.5. Esophagoscopy.- 3.1.6. Diagnosis.- 3.1.7. Complications.- 3.1.8. Treatment.- 3.2. Cysts.- 4. Intraluminal Tumors.- 4.1. Fibrovascular Polyp.- 4.2. Papillomas.- 4.3. Adenomas.- 5. Hemangiomas.- References.- Malignant Tumors of the Esophagus.- 1. Esophageal Carcinoma.- 1.1. Incidence and Etiology.- 1.2. Pathology.- 1.2.1. Squamous Cell Carcinoma.- 1.2.1.1. Site.- 1.2.1.2. Size.- 1.2.1.3. Macroscopic Appearance.- 1.2.1.4. Microscopic Appearance.- 1.2.1.5. Direct Spread.- 1.2.1.6. Lymphatic Metastases.- 1.2.1.7. Blood-Borne Metastases.- 1.2.2. Adenocarcinoma.- 1.2.3. Mixed Squamous and Adenocarcinoma.- 1.3. Clinical Features, Natural History, Symptoms and Signs.- 1.4. Investigations.- 1.4.1. Radiology.- 1.4.2. Endoscopy.- 1.4.3. Esophageal Cytology.- 1.4.4. Cervical Lymph Node Biopsy.- 1.4.5. Mediastinoscopy, Pneumomediastinography and Laparotomy.- 1.4.6. Other Investigations.- 1.5. Prognosis.- 1.5.1. Factors Influencing Prognosis.- 1.5.1.1. The Balance between the Aggressiveness of the Tumor and the Resistance of the Patient.- 1.5.1.2. Treatment.- 1.5.1.3. Sex.- 1.5.1.4. Site.- 1.5.1.5. Histology.- 1.5.1.6. Condition of the Patient.- 1.5.1.7. The Community in which the Patient Lives.- 1.6 Treatment.- 1.6.1. Comparison of Surgery and Radiotherapy.- 1.6.2. Anatomical Classification.- 1.6.3. Radiation Therapy.- 1.6.3.1. Squamous Carcinoma.- 1.6.3.2. The Level of the Esophageal Cancer.- 1.6.3.3. Adenocarcinoma.- 1.6.4. Surgical Treatment.- 1.6.4.1. Complications of Esophagogastrectomy.- 1.6.5. Preoperative and Postoperative Irradiation.- 1.6.6. Intubation.- 1.6.7. Cancer Chemotherapy.- 1.6.8. Treatment of Esophagotracheal Fistula.- 1.6.9. Results of Treatment.- 1.6.9.1. Results of Surgical Management.- 1.6.9.2. Results of Management of Squamous Esophageal Cancer by Irradiation.- 1.6.9.3. Results of Management of Squamous Esophageal Cancer by Irradiation and Surgery.- 2. Sarcoma.- 3. Pseudosarcoma and Carcinosarcoma.- 4. Malignant Melanoma.- 5. Metastatic Tumors.- 6. Other Rare Malignant Tumors of the Esophagus.- 6.1. Carcinoid Tumor.- 6.2. Paget's Disease.- 6.3. Hodgkin's Disease.- 6.4. Granular Cell Myoblastoma.- 6.5. Verrucous Squamous Cell Carcinoma.- Acknowledgements.- References.- 5 Inflammatory Lesions of the Esophagus.- Reflux Esophagitis.- 1. Introduction.- 2. General Considerations.- 2.1. Hiatal Hernia.- 2.2. Esophagitis.- 2.3. Reflux.- 2.4. Heartburn.- 2.5. Pathogenesis.- 3. Clinical Features.- 4. Roentgen Features.- 5. Endoscopy.- 6. Manometry.- 7. Diagnosis and Differential Diagnosis.- 8. Therapy.- 9. Other Types of Reflux Esophagitis.- References.- Lower Esophagus Lined with Columnar Epithelium.- 1. Historical Aspects, Definition, Incidence and Distribution.- 2. Pathologic Anatomy.- 3. Pathophysiology.- 4. Symptomatology.- 5. Diagnosis.- 6. Differential Diagnosis.- 7. Treatment.- References.- Caustic Lesions of the Esophagus.- 1. Incidence.- 2. Etiology.- 3. Pathogenesis.- 4. Pathology.- 4.1. The Acute Necrotic Phase.- 4.2. The Ulceration and Granulation Phase.- 4.3. The Phase of Cicatrization and Stricture Formation.- 5. Clinical Features.- 6. Diagnosis.- 7. Treatment.- References.- Acute Infectious Disease.- 1. Suppurative Esophagitis.- 2. Esophagitis Secondary to Infectious Disease.- References.- Tuberculosis of the Esophagus.- 1. Incidence.- 2. Pathogenesis.- 3. Pathology.- 4. Clinical Features.- 5. Diagnosis.- 6. Complications.- 7. Prognosis.- 8. Treatment.- References.- Syphilis of the Esophagus.- 1. Incidence.- 2. Pathology.- 3. Clinical Features.- 4. Technical Examination.- 5. Diagnosis.- 6. Complications.- 7. Treatment.- References.- Esophageal Mycoses.- 1. Monilial Esophagitis.- 1.1. History.- 1.2. Incidence.- 1.3. Etiology.- 1.4. Pathogenesis.- 1.5. Clinical Features.- 1.6. Technical Examination.- 1.7. Diagnosis and Differential Diagnosis.- 1.8. Complications.- 1.9. Prognosis.- 1.10. Treatment.- 2. Other Mycotic Infections of the Esophagus.- 2.1. Actinomycosis.- 2.2. Mucormycosis.- 2.3. Histoplasmosis.- 2.4. Blastomycosis.- References.- Granulomatous Esophagitis.- 1. Crohn's Disease of the Esophagus.- 2. Sarcoidosis of the Esophagus.- References.- 6.- Esophageal Webs and Rings.- 1. Introduction.- 2. Upper Esophageal Web.- 2.1. Definition.- 2.2. Incidence.- 2.3. Etiology and Pathogenesis.- 2.4. Pathology.- 2.5. Clinical Features.- 2.6. Technical Features.- 2.7. Diagnosis.- 2.8. Differential Diagnosis.- 2.9. Complications and Prognosis.- 2.10. Treatment.- 3. Middle Esophageal Web.- 3.1. Incidence.- 3.2. Etiology.- 3.3. Clinical Features.- 3.4. Technical Features.- 3.5. Diagnosis.- 3.6. Prognosis and Treatment.- 4. Lower Esophageal Web.- 4.1. Incidence and Etiology.- 4.2. Clinical and Technical Features.- 4.3. Diagnosis.- 4.4. Comment.- 5. Squamocolumnar Ring.- 5.1. Definition.- 5.2. Incidence.- 5.3. Etiology and Pathogenesis.- 5.4. Pathology.- 5.5. Clinical Features.- 5.6. Technical Features.- 5.7. Diagnosis.- 5.8. Differential Diagnosis.- 5.9. Complications and Prognosis.- 5.10. Treatment.- 5.11. Comment.- References.- 7.- Esophageal Diverticula.- 1. Lateral Pharyngeal Diverticula and Pouches.- 2. The Hypopharyngeal Diverticulum (Zenker's Diverticulum).- 2.1. Incidence.- 2.2. Pathophysiology and Pathogenesis.- 2.3. Pathology.- 2.4. Symptoms.- 2.5. Diagnosis.- 2.6. Complications of Untreated Diverticula.- 2.7. Evolution and Prognosis.- 2.8. Treatment.- 3. Esophageal Diverticula.- 3.1. Midesophageal Diverticula.- 3.1.1. Pathogenesis and Pathology.- 3.1.2. Symptoms.- 3.1.3. Complications.- 3.1.4. Diagnosis.- 3.1.5. Treatment.- 3.2. Epiphrenic Diverticula.- 3.2.1. Incidence.- 3.2.2. Pathology.- 3.2.3. Etiology.- 3.2.4. Symptoms.- 3.2.5. Diagnosis.- 3.2.6. Complications.- 3.2.7. Treatment.- 3.3. Subphrenic Diverticula.- References.- 8 Congenital Anomalies of the Esophagus.- Esophageal Atresia.- 1. History.- 2. Incidence.- 3. Embryology.- 4. Pathological Anatomy.- 5. Pathophysiology.- 5.1. Hydramnios.- 5.2. Prematurity.- 5.3. Pneumonia.- 6. Associated Anomalies.- 7. Diagnostic Procedures.- 7.1. Nasogastric Intubation.- 7.2. Radiological Examinations.- 8. Treatment.- 8.1. Principles of Management.- 8.2. Preoperative Management.- 8.3. Operative Management.- 9. Anastomotic Complications.- 9.1. Leaks.- 9.2. Strictures.- 9.3. Recurrent Trachoesophageal Fistula.- 9.4. Neurogenic Dysfunction.- 10. Trends in Survival.- References.- Isolated Trachoesophageal Fistula.- References.- Bronchoesophageal Fistula.- References.- Cleft Larynx. Laryngotracheoesophageal Cleft. Persistent Esophagotrachea.- References.- Vascular Rings.- Vascular Anomalies Causing Tracheoesophageal Symptoms.- 1. Introduction.- 2. Clinical Picture.- 2.1. Respiratory Symptoms.- 2.2. Feeding Problems.- 3. Different Types of Anomalies.- 3.1. Aberrant Right Subclavian Artery (A. lusoria).- 3.2. Double Aortic Arch.- 3.3. Right-sided Aortic Arch.- 3.4. Left-sided Aortic Arch with Right-sided Descending Aorta.- 3.5. Cervical Aortic Arch.- 3.6. Aberrant Left Pulmonary Artery.- References.- 9 Mechanical Lesions of the Esophagus.- Traumatic Lesions of the Esophagus.- 1. Pathogenesis.- 1.1. Blunt Trauma.- 1.2. Penetrating Wounds.- 1.3. Mechanical Agents Acting from Inside the Lumen.- 2. Symptoms.- 3. Diagnosis.- 4. Treatment.- References.- Foreign Bodies in the Esophagus.- 1. Incidence.- 2. Pathogenesis and Pathology.- 3. Clinical Features.- 4. Diagnosis.- 5. Treatment.- 6. Complications.- 7. Esophageal Obstruction from Meat Impaction.- References.- Spontaneous Rupture of the Esophagus.- 1. Definition.- 2. History and Incidence.- 3. Pathogenesis.- 4. Pathology.- 5. Clinical Features.- 6. Technical Examinations.- 7. Diagnosis.- 8. Prognosis.- 9. Treatment.- 10. Esophageal Rupture in Children.- References.- Iatrogenic Perforations of the Esophagus.- 1. Definition.- 2. Incidence.- 3. Etiology and Pathogenesis.- 4. Symptoms and Diagnosis.- 5. Treatment.- References.- Mallory-Weiss Syndrome.- 1. Definition.- 2. History.- 3. Incidence.- 4. Pathogenesis.- 5. Clinical Features.- 6. Diagnosis.- 7. Pathology.- 8. Treatment.- References.- Intramural Rupture and Bleeding.- 1. Etiology.- 2. Pathogenesis.- 3. Symptoms.- 4. Radiological Features and Diagnosis.- 5. Treatment.- References.- 10.- Esophageal Varices.- 1. Definition.- 2. Anatomy and Histopathology.- 3. Incidence.- 4. Etiology and Pathogenesis.- 4.1. Esophageal Varices Secondary to "Portal Hypertension".- 4.1.1. Presinusoidal Causes.- 4.1.1.1. Prehepatic Pathology.- 4.1.1.2. Presinusoidal Intrahepatic Disorders.- 4.1.2. Sinusoidal Causes.- 4.1.2.1. Acute Hepatitis.- 4.1.2.2. Fatty Liver.- 4.1.2.3. Early Stage of Chronic, Non-Suppurative, Destructive Cholangitis (Primary Biliary Cirrhosis).- 4.1.2.4. Kupffer Cell Hypertrophy with Perisinusoidal Fibrosis.- 4.1.3. Postsinusoidal Portal Hypertension.- 4.1.3.1. Postsinusoidal Intrahepatic Causes.- 4.1.3.2. Extrahepatic Postsinusoidal Portal Hypertension.- 4.2. Esophageal Varices without Portal Hypertension.- 4.2.1. Obstruction of Vena Cava Superior (Downhill Varices).- 4.2.2. Carcinoma at the Gastroesophageal Junction.- 4.2.3. Idiopathic Esophageal Varices.- 4.2.4. Esophageal Varices in Patients with Liver Disease, but Normal Portal Pressure.- 4.3. Unclassified Miscellaneous Causes.- 5. Clinical Features: Bleeding.- 5.1. Incidence.- 5.2. Pathogenesis of the Bleeding.- 5.3. Clinical Symptoms.- 6. Diagnosis.- 6.1. Diagnosis of Esophageal Varices.- 6.1.1. Barium Swallow.- 6.1.2. Esophagoscopy.- 6.1.3. Splenoportography.- 6.1.4. Umbilical Vein Portography.- 6.1.5. Ammonia Tolerance; Indirect Test for Esophageal Varices.- 6.1.6. Evaluation of the Different Techniques Used.- 6.2. Diagnosis of Bleeding from Esophageal Varices.- 7. Therapy.- 7.1. Medical Management of Bleeding Varices.- 7.1.1. Blood Transfusion.- 7.1.2. Prevention of Hepatic Encephalopathy (in Cirrhotics).- 7.1.3. Arrest of Further Bleeding.- 7.1.3.1. Drugs.- 7.1.3.2. Gastric Cooling.- 7.1.3.3. Balloon Tamponade.- 7.1.3.4. Intraarterial Infusion.- 7.2. Surgical Management of Bleeding Esophageal Varices.- 7.2.1. Emergency Surgical Treatment.- 7.2.2. Elective Surgical Treatment in Liver Cirrhosis with Bleeding Varices.- 7.2.3. Prophylactic Shunt Operations in Liver Cirrhosis.- 7.2.4. Prophylactic Operations in Extrahepatic Block.- 7.3. Thoracic Duct Drainage.- 7.4. Transumbilical Portal Decompression.- 7.5. Sclerosing Injections for Esophageal Varices.- References.- 11.- Hiatus Hernia.- 1. Definition and Classification.- 2. Incidence.- 3. Anatomical Basis, Etiology and Pathogenesis.- 4. Pathological Anatomy.- 5. Clinical Features.- 5.1. Symptoms.- 5.2. Hiatus Hernia in Infants.- 5.3. Hiatus Hernia during Pregnancy.- 5.4. Postoperative Hernias.- 5.5. Traumatic Hiatus Hernias.- 5.6. Signs.- 6. Technical Features.- 6.1. Radiological Examination.- 6.1.1. Technique of X-ray Examination.- 6.1.2. Radiological Demonstration of Reflux.- 6.1.3. Interpretation of X-ray Findings.- 6.1.4. Paraesophageal Hernia.- 6.1.5. Mixed Hernias.- 6.1.6. Invagination.- 6.1.7. Note on Terminology.- 6.2. Endoscopy.- 6.2.1. Esophagoscopy.- 6.2.2. Gastroscopy.- 6.2.3. Peritoneoscopy.- 6.3. Manometry.- 6.4. pH Measurements.- 6.5. Acid Infusion Test.- 7. Diagnosis.- 8. Complications.- 9. Associated Diseases.- 10. Evolution and Prognosis.- 11. Therapy.- 11.1. Medical Treatment.- 11.2. Surgical Treatment.- References.- 12.- Resection and Reconstruction of the Esophagus.- 1. Resection of the Esophagus.- 1.1. Postoperative Complications.- 2. Replacement of the Esophagus.- 2.1. Mortality and Morbidity of the Esophageal Substitution.- 2.1.1. Necrosis of the Esophageal Substitute.- 2.1.2. Leakage at the Anastomosis.- 2.1.3. Other Complications.- 2.2. Functional Results.- References.- 13.- Etiology and Non-Surgical Treatment of Organic Esophageal Stenosis.- 1. Etiology.- 2. Techniques of Dilatation.- 3. Indications for Dilatations.- 3.1. Benign Strictures.- 3.2. Malignant Stenoses.- References.- 14.- Acquired Esophageal Fistula.- 1. Esophagorespiratory Fistula.- 1.1. Etiology.- 1.1.1. Malignant Esophageal Fistula.- 1.1.2. Esophagorespiratory Fistula of Benign Origin.- 1.1.2.1. Traumatic Fistula.- 1.1.2.2. Fistula Secondary to Esophageal Diverticulum.- 1.1.2.3. Infectious Fistula.- 1.1.2.4. Esophageal Fistula and Bronchopulmonary Sequestration.- 1.2. Location of the Fistula.- 1.3. Symptoms.- 1.4. Diagnosis.- 1.5. Treatment.- 2. Aortoesophageal Fistula.- 2.1. Benign Aortoesophageal Fistula.- 2.2. Malignant Aortoesophageal Fistula.- 2.3. Other Fistulas between the Esophagus and the Cardiovascular System.- 2.3.1. Fistula between the Esophagus and the Pericardial Cavity.- 2.3.2. Kommerell's Diverticulum.- 2.3.3. Esophagocardiac Fistula.- 2.3.4. Fistula between Larger Veins and Esophagus.- 3. Esophagocavitary Fistulas.- 3.1. Etiology and Pathogenesis.- 3.2. Localization.- 3.3. Symptoms.- 3.4. Diagnosis.- 3.5. Treatment.- 4. External Esophageal Fistula.- References.- 15.- The Esophagus in Cutaneous Diseases.- 1. Bullous Dermatoses.- 1.1. Pemphigus.- 1.2. Bullous Pemphigoid (Parapemphigus).- 1.3. Benign Mucosal Pemphigoid (Cicatricial Pemphigoid).- 1.4. Epidermolysis Bullosa Dystrophica.- 1.5. Toxic Epidermal Necrolysis (Lyell's Disease, Ritter's Disease).- 1.6. The Stevens-Johnson Syndrome.- 1.7. Recurrent Aphtae.- 1.8. Esophagitis Superficialis Dissecans. Benign or Idiopathic Esophageal Casts.- 2. Disorders of Keratinization.- 2.1. Keratosis Follicularis, Darier's Disease.- 2.2. Keratoderma.- 2.3. Acanthosis Nigricans.- 3. Hypertrophic Osteoarthropathy.- 4. Dermatomyositis.- 5. Leukoplakia and Other Yellow-White Spots on the Esophageal Mucosa.- References.- 16.- Miscellaneous and Rare Diseases.- 1. Idiopathic Retroperitoneal Fibrosis.- 2. Amyloidosis.- 3. Lupus Erythematosus Disseminatus.- 4. Intramural Diverticulosis.- 5. Pneumatosis Cystoides.- 6. Eosinophilic Granuloma.- 7. Extensive Necrosis of the Esophagus.- 8. Esophagogastric Invagination. Transmigration of the Esophageal Mucosa.- 9. Cervical Osteophytes. External Compression.- 10. Ulcerative Colitis.- 11. Pancreatitis.- 12. Amebic Abcess.- 13. Worms.- 13.1. Hydatid Cyst.- 13.2. Spirocerca Lupus.- 14. Ectopic Tissues.- 14.1. Primary Melanosis of the Esophagus.- 14.2. Sebaceous Glands.- 14.3. Liver Tissue.- 14.4. Pancreatic Tissue.- 14.5. Heterotopic Gastric Mucosa.- 14.6. Tracheobronchial Remnants.- 14.7. Aberrant Origin of Right Main Bronchus.- 14.8. Thyroid Tissue.- References.