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DIFFERENTIAL DIAGNOSIS
OF
NEUROMUSCULAR DISEASE
OF
THE ESOPHAGUS
AND
ESOPHAGOCARDIA CANCER
BY
DR. INNOCENT KINGSLEY ASOGWA...
DDx OF ACHALAZIA AND CARDIOSPASM
Condition
Differentiating
signs/symptoms
Differentiating
tests
Oesophageal
carcinoma
•Dys...
ACHALASIA
ESOPHAGOCARDIA CANCER
ESOPHAGOCARDIA CANCER
Reflux oesophagitis •Can give rise to
dysphagia through
inflammatory swelling
or a fibrotic peptic
stricture, sometimes
ev...
BARRET ESOPHAGUS & ESOPHAGEAL
REFLUX
Connective
tissue
disorders (e.g.,
systemic
sclerosis)
•Muscle and
joint pain,
Raynaud's
phenomenon,
skin changes
(e.g., r...
Oesophageal
spasm
•Chest pain is
often more
prominent
than
dysphagia,
which tends
to be
intermittent.
•Manometry
shows hig...
DIFFUSE ESOPHAGEAL SPASM
Eosinophilic
oesophagitis
•Presents with
dysphagia, or
food bolus
obstruction,
often in young
men with history
of atopy.
•...
EOSINOPHILIC OESOPHAGITIS
Pseudoachalasia
(or secondary
achalasia)
•Underlying
malignancy that
mimics idiopathic
achalasia.
•Patients tend to
be old...
PSEUDOACHALASIA
(OR SECONDARY ACHALASIA)
Chagas' disease •Endemic to
Latin America;
multiple-organ
involvement
probably causing
atonic colon,
myocarditis, and
Roma...
Differential diagnosis of neuromuscular disease of the esophagus and esophagocardia cancer by dr. innocent kingsley asogwa
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Differential diagnosis of neuromuscular disease of the esophagus and esophagocardia cancer by dr. innocent kingsley asogwa

Differential diagnosis of neuromuscular disease of the esophagus and esophagocardia cancer by dr. innocent kingsley asogwa

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Differential diagnosis of neuromuscular disease of the esophagus and esophagocardia cancer by dr. innocent kingsley asogwa

  1. 1. DIFFERENTIAL DIAGNOSIS OF NEUROMUSCULAR DISEASE OF THE ESOPHAGUS AND ESOPHAGOCARDIA CANCER BY DR. INNOCENT KINGSLEY ASOGWA PFURMI ML – 608
  2. 2. DDx OF ACHALAZIA AND CARDIOSPASM Condition Differentiating signs/symptoms Differentiating tests Oesophageal carcinoma •Dysphagia is mainly for solids, although difficulty in swallowing liquids develops with advanced disease. •Weight loss may be severe. •Barium swallow and endoscopy will show oesophageal obstruction by the tumour.
  3. 3. ACHALASIA
  4. 4. ESOPHAGOCARDIA CANCER
  5. 5. ESOPHAGOCARDIA CANCER
  6. 6. Reflux oesophagitis •Can give rise to dysphagia through inflammatory swelling or a fibrotic peptic stricture, sometimes even in the absence of endoscopic abnormalities. •The patient will usually also report heartburn and acid regurgitation in addition to dysphagia. •Endoscopy usually shows reflux oesophagitis, with or without a peptic stricture. A hiatus hernia may be present below the stricture. •Barium swallow has low sensitivity for oesophagitis but will show up strictures and hiatus hernias. Gastro- oesophageal reflux will likely be demonstrated. •Lower oesophageal pH studies will demonstrate
  7. 7. BARRET ESOPHAGUS & ESOPHAGEAL REFLUX
  8. 8. Connective tissue disorders (e.g., systemic sclerosis) •Muscle and joint pain, Raynaud's phenomenon, skin changes (e.g., rash, skin swelling or thickening). •Antinuclear antibodies, rheumatoid factor, creatine kinase, and ESR are useful initial screening tests for connective tissue pathology.
  9. 9. Oesophageal spasm •Chest pain is often more prominent than dysphagia, which tends to be intermittent. •Manometry shows high- amplitude oesophageal contractions rather than the aperistalsis usually seen in achalasia.
  10. 10. DIFFUSE ESOPHAGEAL SPASM
  11. 11. Eosinophilic oesophagitis •Presents with dysphagia, or food bolus obstruction, often in young men with history of atopy. •Endoscopy may show a ringed oesophagus with furrows and white spots. Esophageal biopsy shows eosinophilic infiltration (>15 eosinophils per high-power field).
  12. 12. EOSINOPHILIC OESOPHAGITIS
  13. 13. Pseudoachalasia (or secondary achalasia) •Underlying malignancy that mimics idiopathic achalasia. •Patients tend to be older, duration of symptoms shorter, and weight loss greater and more rapid. •Dysphagia is clinically indistinguishable. •Gastroscopic biopsy of gastro- oesophageal junction and cardia may demonstrate malignancy. •Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia.
  14. 14. PSEUDOACHALASIA (OR SECONDARY ACHALASIA)
  15. 15. Chagas' disease •Endemic to Latin America; multiple-organ involvement probably causing atonic colon, myocarditis, and Romana sign; swelling of the eyelids in acute disease. •Microscopic examination of fresh blood with Giemsa staining of thick and thin blood films showing presence of Trypanosoma cruzi. •PCR for precise identification of trypanosome

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