The main symptoms of<unk>  are dysphagia (difficulty in swallowing), regurgitation of undigested food, chest pain behind the sternum, and weight loss. Dysphagia tends to become progressively worse over time and to involve both fluids and solids. Some people may also experience coughing when lying in a horizontal position. The chest pain experienced, also known as cardiospasm and non-cardiac chest pain can often be mistaken for a heart attack. It can be extremely painful in some sufferers. Food and liquid, including saliva, are retained in the esophagus and may be inhaled into the lungs (aspiration). Untreated, mid-stage<unk>  can fully obstruct the passage of almost any food or liquid - the greater surface area of the swallowed object often being more difficult to pass the LES/LOS (lower<unk>  sphincter). At such a stage, upon swallowing food, it entirely remains in the esophagus, building up and stretching it to an extreme size in a phenomenon known as Megaesophagus. If enough food builds up, it triggers a need to purge what was swallowed, often described as not being accompanied with nausea per-se, but an intense - sometimes uncontrollable need to vomit what was built up in the esophagus, that due to the excessive stretching of the<unk>  walls, is easily released without heaving. This cycle is so that little to practically no food reaches the small intestines to have its nutrients be absorbed into the bloodstream, leading to progressive weight loss, anorexia, eventual starvation, and death, the final of which may not always be listed as "death by<unk> ", contributing to the already inaccurate and/or inconclusive count of deaths caused by the disease, not to mention the variable of other medical factors that could accelerate death of an<unk>  sufferer's already weakened body. Late-Stage<unk>  End-stage<unk> , typified by a massively dilated and tortuous oesophagus, may occur in patients previously treated but where further dilatation or myotomy fails to relieve dysphagia or prevent nutritional deterioration, and oesophagectomy may be the only option. We describe two patients with end-stage<unk>  and nutritional failure despite exhaustive conventional therapy including pneumatic dilatation and surgical myotomy. Both patients were successfully managed with transhiatal oesophagectomy and cervical gastro-esophageal anastomosis, with excellent symptomatic control and improved quality of life. These cases are discussed and the literature reviewed. End stage disease, characterised by a markedly dilated and tortuous “burned- out” oesophagus and recurrent obstructive symptoms, may require<unk>  resection in order to restore gastro-intestinal function, reverse nutritional deficits and reduce the risk of aspiration pneumonia. Transhiatal oesophagectomy specimen from a patient suffering from late-stage<unk> . Diverticulum at the left lower end of the oesophagus. A review of the literature shows similar results with good symptom control reported in 75–100% of patients undergoing such a procedure. However, oesophagectomy is not without risk, and every patient must be fully informed of all associated risks. Reported mortality rates of 5–10% are described, while morbidity rates of up to 50% have been reported, and anastomotic leak in 10–20% of patients. Patients must also be informed of longer-term complications. Anastomotic stricture has been reported in up to 50% of patients, depending on length of post-operative follow-up.11 Dumping syndrome, reported in up to 20% of patients,16 tends to be self-limiting and may be managed medically if necessary, and vagal-sparing oesophagectomy may reduce this risk.
Esophageal achalasia
Esophageal spasm
Nutcracker esophagus
Esophagogastric junction outflow obstruction
Esophageal web
Megaesophagus
Diffuse esophageal spasm
Esophageal stricture