Some Pathological Conditions of the Esophagus; Functional Disturbances, Diverticuli, Varices and Reflux Esophagitis

Abstract

1. Some standard series of esophagoscopes do not include tubes of sufficient length. Under certain conditions tubes at least 50 cm long are required, preferably with proximal illumination, in which case the view is not impeded by retained food remnants.

2. General anesthesia should be used at esophagoscopy in the majority of cases.

3. A functional disturbance, appropriately designated “cricopharyngeal achalasia”, occurs at the esophageal mouth, in addition to spasm. In different spastic conditions of the esophagus, dilatation should be tried along with medication. Dilatation may have a striking effect and can be repeated if the effect should prove temporary.

4. A hereditary weakness in the posterior hypopharyngeal wall is an important factor in the causation of Zencker's diverticulum in a number of cases, though in these, too, the disease appears fairly late in life.

5. Laryngolists should receive training in the treatment of acute hemorrhage from esophageal varices with a compression bougie. Owing to the modern shunt operations for portal hypertension, treatment with sclerosing endoscopic injections of the varices has lost much of its earlier importance, yet it seems still to be useful in certain cases.

6. Each patient with symptoms which may be referable to reflux esophagitis should be subjected to esophagoscopy, if no other clear and sufficient cause for the symptoms has been established. Esophagoscopy is the only sure means of diagnosing esophagitis. Our aim should be to reach a correct diagnosis early—before the development of the stenosing stage, which is much more difficult to cure.