Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

556 Esophageal Infections and Inflammation Esophageal Motor Disorders

■patients with pill-induced esophagitis rarely develop perforation,

mediastinitis, or stricture formation requiring surgical correction or

repeated endoscopic dilation

■in patients with caustic esophageal injury, there is a high risk (up to

65%) of acute complications, including perforation with mediastini-

tis or peritonitis, bleeding, stricture, or esophageal-tracheal fistulas.

These patients should be monitored closely for signs of deterioration

that warrant emergency surgery with possible esophagectomy and

colonic or jejunal interposition.

Prognosis

■related to underlying condition

■life span not affected in pill-induced esophagitis

■after caustic injury there is an increased risk of esophageal squamous

cancer of approximately 2–3% per year, and endoscopic surveillance

is recommended starting approximately 15 years after ingestion.

■10–15% of patients with chronic GERD may have a precancerous

condition called Barrett’s esophagus (BE) that can be detected on

upper endoscopy. Once BE is detected, the annual risk of esophageal

adenocarcinoma is approximately 0.5% per year. Society guidelines

recommend endoscopic surveillance every 3 years or more fre-

quently if dysplasia is present. Some case-control studies have sug-

gested improved survival if esophageal adenocarcinoma is detected

via a surveillance program.

Esophageal Motor Disorders............................

GEORGE TRIADAFILOPOULOS, MD

history & physical

■Esophageal motor disorders: functional abnormalities associated

with increased or decreased esophageal contractility or uncoordi-

nated esophageal peristalsis that result in dysphagia or chest pain

History

■Patients with generalized intestinal dysmotility, Chagas’ disease, col-

lagen vascular disease or infiltrative disorder (ie. amyloidosis)

■Patients with gastric cardia cancer: secondary achalasia

■Chronic GERD: may be complicated by esophageal motor dysfunc-

tion