Postoperative achalasia, hiatal hernia, increased intra-abdominal pressure (such as pregnancy, obesity, abdominal effusion, constipation, vomiting, weight-bearing labor, etc.) and long-term increased intragastric pressure (delayed gastric emptying, gastric dilatation, etc.) )

Common diseases involving abnormal esophageal motility and decreased saliva secretion

Long-term drinking, smoking, irritating foods or drugs can impair the barrier function of the esophageal mucosa against reflux material.

Typical symptoms

Atypical symptom

Caused by reflux that irritates or damages unintentional tissues or organs in the esophagus, such as pharyngitis, chronic cough, asthma, and dental erosion

1. Upper gastrointestinal bleeding

2. Esophageal stenosis

3. Barrett’s esophagus

①Have symptoms of reflux or heartburn

②Reflux esophagitis found under gastroscopy

①Have symptoms of reflux or heartburn

②Gastroscopy negative

③24-hour gastric tube

④PPI treatment is effective

Infectious esophagitis, eosinophilic esophagitis, drug-induced esophagitis, achalasia, esophageal cancer, peptic ulcer, biliary tract disease, etc.

Acid suppressants

Gastrointestinal motility drugs

antacids

Refractory GERD

Maintenance treatment

You should not lie down in bed immediately after eating. You should not eat 2 hours before going to bed. You can raise the head of the bed 15-20cm while sleeping.

Reduce factors that cause increased intra-abdominal pressure: constipation, obesity, tight belts, etc.; avoid eating high-fat, chocolate, coffee, strong tea, etc.; use nitroglycerin and calcium channel blockers (nifedipine, benzenesulfonic acid) with caution Amlodipine, nimodipine, verapamil extended-release tablets, felodipine), anticholinergic drugs (atropine, anisodamine, scopolamine, probenzoline, belladonna)

laparoscopic fundoplication

upper gastrointestinal bleeding

Esophageal stricture

Barrett's esophagus

Mycotoxins: Fungi such as aflatoxin and Fusarium in moldy food can not only reduce nitrates to nitrites, but also promote the synthesis of carcinogens such as nitrosamines, and often collaborate with nitrosamines to cause cancer.

Chronic physical and chemical irritation to the esophageal mucosa, such as long-term smoking and drinking, eating rough and hot foods, and inflammation caused by chronic esophageal diseases such as gastroesophageal reflux disease, corrosive esophageal burns and strictures, achalasia, and esophageal diverticula can all cause Causes increased incidence of esophageal cancer

Risk factors for esophageal cancer when micronutrients such as vitamins (A, B2, C, E, folic acid, etc.), zinc, selenium, and molybdenum are deficient

The paternal line is the highest, the maternal line is second, and the collateral line is the lowest

Early esophageal cancer

Intermediate and advanced esophageal cancer

90% of esophageal cancers are squamous cell carcinomas, and a small number are adenocarcinomas (mostly related to Barrett's esophagus)

1. Direct spread: first infiltrates into the submucosa and muscle layer, penetrates the esophageal wall and then spreads to surrounding tissues and organs

2. Lymphatic metastasis: main mode of transfer

3. Hematogenous metastasis: in the late stage, it often metastasizes to the liver, lungs, bones, etc.

Retrosternal discomfort, burning sensation, and pinprick or pulling-like pain, which may include slow passage of food, retention, or mild choking sensation

1. Progressive dysphagia: typical symptoms of intermediate and advanced esophageal cancer

2. Food reflux

3. Pain in swallowing

4. Other symptoms: Tumor compression of the recurrent laryngeal nerve can cause hoarseness and coughing; invasion of the phrenic nerve can cause hiccups; liver metastasis can cause jaundice; bone metastasis can cause pain; invasion of the trachea and bronchi can cause esophageal-bronchial fistula, Mediastinal abscess, pneumonia, lung abscess, etc.; invasion of the aorta can cause fatal bleeding.

In the late stage, weight loss, anemia, malnutrition, dehydration or cachexia may occur. After metastasis occurs, swollen and hard superficial lymph nodes or swollen and nodular liver are often touched. A few patients may develop abdominal or pleural effusion.

early esophageal cancer

advanced esophageal cancer

The resection rate is 58%~92%, and early resection can achieve a radical cure effect.

It is mainly suitable for patients with upper esophageal cancer and those with contraindications for surgery. It can also be used for preoperative or postoperative treatment.