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Esophageal Achalasia01:27

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Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide...
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Hiatal Hernia01:25

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A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or...
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Gastroesophageal Reflux Disease01:25

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Gastroesophageal reflux disease (GERD) is the backward flow of stomach contents (acid, pepsin, or bile) into the esophagus, causing mucosal inflammation known as esophagitis. It results from failure of antireflux mechanisms, mainly the lower esophageal sphincter (LES), influenced by mechanical and physiological factors.Etiology and Risk FactorsGERD develops when LES function is weakened or when intra-abdominal pressure increases. Risk factors include aging, obesity, and sliding hiatal hernia,...
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Diverticular Disease of the Colon01:27

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Diverticular disease involves the formation of diverticula—small sac-like outpouchings of the colonic wall—and their complications. It most commonly affects the sigmoid colon due to higher intraluminal pressure and structural vulnerability. It results from structural weakness and increased pressure in the colon, producing pseudodiverticula that may remain silent or progress to inflammation and serious complications.Structure of DiverticulaIn diverticulosis, these outpouchings are...
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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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Gastroesophageal Reflux Disease (GERD) involves the recurrent backflow of the stomach or duodenal contents into the esophagus, leading to troublesome symptoms and potential esophageal mucosal damage. Although GERD is often referred to as a disease, it is more accurately described as a syndrome, as it encompasses a range of symptoms and complications rather than a singular pathological entity, impacting a large number of individuals as the most prevalent upper gastrointestinal problem. Roughly...
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Robotic Myotomy and Partial Fundoplication for Achalasia
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Upper esophageal sphincter dysfunction: diverticula-globus pharyngeus.

Antonio Schindler1, Francesco Mozzanica1, Enrico Alfonsi2

  • 1Department of Biomedical and Clinical Sciences "L. Sacco,", University of Milan, Milan, Italy.

Annals of the New York Academy of Sciences
|October 15, 2013
PubMed
Summary

Upper esophageal sphincter dysfunction is discussed, covering cricopharyngeus muscle roles in reflux, Zenker diverticulum, and diagnostic tools like videofluoroscopy and pH-impedance monitoring for swallowing issues and globus.

Keywords:
GERDUESZenker diverticulumcricopharyngeusimpedance-pHvideofluoroscopy

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Area of Science:

  • Gastroenterology and Otolaryngology

Background:

  • Upper esophageal sphincter (UES) dysfunction can manifest in various conditions, impacting swallowing and quality of life.
  • The cricopharyngeus muscle plays a critical role in UES function and its involvement in gastroesophageal reflux disease (GERD) is a key area of study.

Purpose of the Study:

  • To provide a comprehensive overview of upper esophageal sphincter dysfunction.
  • To discuss the etiology and management of Zenker diverticulum.
  • To explore diagnostic modalities and treatment strategies for reflux-associated globus and dysphagia.

Main Methods:

  • Review of current literature and clinical commentaries on UES dysfunction.
  • Discussion of videofluoroscopy for evaluating dysphagia, aspiration risk, and globus sensation.
  • Analysis of pH-impedance monitoring in the assessment of globus.

Main Results:

  • The cricopharyngeus muscle's role in reflux disease is examined.
  • Etiology and treatment options for Zenker diverticulum are presented.
  • The utility of videofluoroscopy and pH-impedance monitoring in diagnosing swallowing disorders and globus is highlighted.

Conclusions:

  • Understanding UES dysfunction is crucial for managing various upper aerodigestive tract conditions.
  • Videofluoroscopy and pH-impedance monitoring are valuable tools in the diagnostic armamentarium.
  • Effective management strategies exist for reflux-associated globus and related swallowing difficulties.