Megaesophagus - Clinicals, Diagnosis, and Management

Gastroenterology

Clinicals - History

Fact Explanation
Dysphagia Long lasting non-progressive dysphagia is characteristic of motility disorders of the esophagus, which lead to megaesophagus. Dysphagia to liquids is commoner than to solids. Dysphagia
Long lasting non-progressive dysphagia is characteristic of motility disorders of the esophagus, which lead to megaesophagus. Dysphagia to liquids is commoner than to solids.
Stridor Stridor is a relatively rare but significant complication of megaesophagus. Dilated esophagus causes pressure effects and compresses the upper airway, leading to stridor. Compression of the superior vena cava leads to venous congestion of the airway and airway edema, which further narrows the airway. Stridor
Stridor is a relatively rare but significant complication of megaesophagus. Dilated esophagus causes pressure effects and compresses the upper airway, leading to stridor. Compression of the superior vena cava leads to venous congestion of the airway and airway edema, which further narrows the airway.
Symptoms of esophageal carcinoma Patients with megaesophagus may progress to squamous cell carcinoma of the esophagus, due to chronic stasis of food and irritation of the epithelium. Patients present with short duration of progressive dysphagia on top of chronic non-progressive dysphagia. Symptoms of esophageal carcinoma
Patients with megaesophagus may progress to squamous cell carcinoma of the esophagus, due to chronic stasis of food and irritation of the epithelium. Patients present with short duration of progressive dysphagia on top of chronic non-progressive dysphagia.
Symptoms of achalasia cardia Patients with achalasia cardia are at risk of developing megaesophagus. Achalasia presents with dysphagia and regurgitation of undigested food particles. Typically dysphagia is prominent for liquids than for solids. Symptoms of achalasia cardia
Patients with achalasia cardia are at risk of developing megaesophagus. Achalasia presents with dysphagia and regurgitation of undigested food particles. Typically dysphagia is prominent for liquids than for solids.
History of diabetic neuropathy Patients with poorly controlled diabetes develop diabetic autonomic neuropathy and uncoordinated peristalsis of the esophagus and megaesophagus. Nausea, vomiting, change in bowel habits, and dizziness are symptoms of diabetic autonomic neuropathy. History of diabetic neuropathy
Patients with poorly controlled diabetes develop diabetic autonomic neuropathy and uncoordinated peristalsis of the esophagus and megaesophagus. Nausea, vomiting, change in bowel habits, and dizziness are symptoms of diabetic autonomic neuropathy.
History of Chagas disease Patients with chronic Chagas disease develop megaesophagus as a complication. Patients with acute Chagas disease have fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting. After an asymptomatic phase, patients develop cardiac and intestinal complications. History of Chagas disease
Patients with chronic Chagas disease develop megaesophagus as a complication. Patients with acute Chagas disease have fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting. After an asymptomatic phase, patients develop cardiac and intestinal complications.
History of Parkinson's disease Parkinson's disease is also associated with increased risk of megaesophagus. History of Parkinson's disease
Parkinson's disease is also associated with increased risk of megaesophagus.

Clinicals - Examination

Fact Explanation
Signs of respiratory distress Patients with megaesophagus and tracheal compression can present in respiratory distress. These patients are tachypnoec cyanosed and gasping for breath. Stridor is a common finding in patients with tracheal obstruction. Signs of respiratory distress
Patients with megaesophagus and tracheal compression can present in respiratory distress. These patients are tachypnoec cyanosed and gasping for breath. Stridor is a common finding in patients with tracheal obstruction.
Swelling of the neck Some patients with significant megaesophagus and food accumulation may have neck swelling. The swelling is diffuse, firm and non-tender. Swelling of the neck
Some patients with significant megaesophagus and food accumulation may have neck swelling. The swelling is diffuse, firm and non-tender.
Dilated neck veins Dilatation of the superficial veins in the neck occurs due to esophageal dilatation and compression of the superior vena cava. Dilated neck veins
Dilatation of the superficial veins in the neck occurs due to esophageal dilatation and compression of the superior vena cava.
Signs of lower respiratory tract infection Patients with megaesophagus can develop secondary respiratory tract infection due to aspiration. Lobar consolidation can be detected commonly over the right lower lobe. The affected lobe shows reduced chest expansion, dull percussion note and reduced breath sounds. Patients are often febrile due to infection. Signs of lower respiratory tract infection
Patients with megaesophagus can develop secondary respiratory tract infection due to aspiration. Lobar consolidation can be detected commonly over the right lower lobe. The affected lobe shows reduced chest expansion, dull percussion note and reduced breath sounds. Patients are often febrile due to infection.

Investigations - Diagnosis

Fact Explanation
Uppergastrointestinal endoscopy (UGIE) UGIE reveals grossly dilated and tortuous oesophagus. Uppergastrointestinal endoscopy (UGIE)
UGIE reveals grossly dilated and tortuous oesophagus.
Barium swallow test Barium swallow shows dilated esophagus. Bird beak appearance is seen in achalasia. Barium swallow test
Barium swallow shows dilated esophagus. Bird beak appearance is seen in achalasia.
Chest X-ray Chest X-ray shows the megaesophagus as a large air- filled swelling. Chest X-ray
Chest X-ray shows the megaesophagus as a large air- filled swelling.
CT scan CT scan can also detect the dilated esophagus. There is no demonstrable esophageal stenosis. CT scan
CT scan can also detect the dilated esophagus. There is no demonstrable esophageal stenosis.

Management - Supportive

Fact Explanation
Airway management Patients who present with signs of acute respiratory distress should be given oxygen. Assessment and maintenance of the patency of the airway is lifesaving. Timely endotracheal intubation or emergency tracheostomy are necessary in some patients.
Nasogastric decompensation of the esophagus is an effective in restoring the airway patency in an emergency.
Airway management
Patients who present with signs of acute respiratory distress should be given oxygen. Assessment and maintenance of the patency of the airway is lifesaving. Timely endotracheal intubation or emergency tracheostomy are necessary in some patients.
Nasogastric decompensation of the esophagus is an effective in restoring the airway patency in an emergency.
Decompression of the esophagus Decompression of the food filled esophagus with a wide-bore nasogastric tube provides immediate symptomatic relief, especially in patients with stridor due to tracheal compression. Nasogastric decmopression can be difficult in some patients due to impacted solid food particles, in which instances intensive manual disimpaction is necessary. Decompression of the esophagus
Decompression of the food filled esophagus with a wide-bore nasogastric tube provides immediate symptomatic relief, especially in patients with stridor due to tracheal compression. Nasogastric decmopression can be difficult in some patients due to impacted solid food particles, in which instances intensive manual disimpaction is necessary.

Management - Specific

Fact Explanation
Surgery Esophagectomy and esophagogastric anastamosis is indicated in the treatment of symptomatic megaesophagus. Heller's myotomy and fundoplication, or esophageal resection is used in advanced disease. Surgery
Esophagectomy and esophagogastric anastamosis is indicated in the treatment of symptomatic megaesophagus. Heller's myotomy and fundoplication, or esophageal resection is used in advanced disease.

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