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ENT
CONDITIONS

Esophageal disorders

The oesophageal diseases may produce:

  • Dysphagia

  • Pain

  • Regurgitation

  • Pulmonary symptoms

  1. Cough

  2. Dyspnoea

  3. Hoarseness

  • Spread of malignancy with metastatic lymph nodes.

  • Loss of weight, dehydration, cachexia.


Dysphagia

Among all the oesophageal symptoms, dysphagia is the most common. The word dysphagia means difficulty in swallowing while painful swallowing is called odynophagia.


Corrosive burns, strictures

Corrosive poisoning may be suicidal or accidental caused by swallowing acids or alkalies. The corrosive causes severe burns with deep necrosis and ulceration. Depending on the concentration and quantity of corrosives, scarring, stricture or perforation may occur.


The corrosive causes burns on the lips and in oral cavity. Laryngeal oedema may follow laryngeal burns.


Plummer Vinson Syndrome

This is a syndrome of gradually progressive dysphagia to solids with hypochromic, microcytic anaemia and chronic superficial pharyngo-oesophagitis.


Oesophageal Hypermotility

Hypermotility of oesaphagus can be of 3 types:

  • Cricopharyngeal spasm which is often nerocgenic

  • Diffuse oesophageal spasm is caused by non-peristaltic contraction of the oesophagus while relaxation of the sphincters is normal.

  • Nut cracker oesophagus caused by hypermotile peristaltic movements of the oesophagus.


Gastro-Oesophageal Reflux

This condition is now being increasingly recognised for causing many unexplained symptoms in the throat like reflux laryngitis and pharyngitis.


Achalasia Cardia (Cardiospasm)

This is a condition characterised by failure of relaxation of the lower oesophageal sphincter for the passage of food. There is marked dilation, elongation and torturosity of the lower third of the oesophagus.


Carcinoma of the Oesophagus

Squamous cell carcinoma is the most common type of malignant tumour of the oesophagus.

Causes

Causes of dysphagia


OESOPHAGEAL

  • In the Lumen

  1. Foreign body

  2. Large bolus


  • In the wall

(A) Congenital:

  1. Tracheo-oesophageal fistula

  2. Stricture

(B) Traumatic:

  1. Corrosive poisoning

  2. Stricture as a result of corrosive poisoning

(C) Inflammation: 

  1. Corrosive poisoning

  2. Hiatus hernia with lower oesophagitis

  3. After exanthemata

(D) Neoplasms:

  1. Leiomyoma

  2. Carcinoma of the oesophagus

(E) Neurological

  1. Paralytic

  2. Spasm of the cricopharynx and oesophagus

  3. Tetanus

  4. Myasthenia gravis

(F) Miscellaneous:

  1. Paterson-Brown Kelly syndrome (Plummer-Vinson Syndrome)

  2. Achalasia (cardiospasm)

  3. Diverticulum


Dysphagia Lusoria

Vascular anomalies in the chest may press on the oesophagus and cause dysphagia. Common causes are:

  • Right aortic arch

  • Double aortic arch

  • Aberrant right subclavian artery or abnormal innominate artery.

  • Constrictive ring formed by patent ductus arteriosus.

Diganosis is by CT Scan and Aortography.


Stricture of the oesophagus

  • Congenital

  • Traumatic: Corrosive strictures, foreign bodies, postoperative.

  • Inflammation: Reflux oesophagitis.

  • Malignant strictures.


Plummer Vinson Syndrome

  • Sex: It predominantly affects females. 

  • Age: It usually occurs above the age of 40 years.

  • Iron Deficiency Anaemia and vitamin deficiency are present, which can be the cause as well as result of dysphagia.


Achalasia Cardia (Cardiospasm)

The exact cause is not known. Various theories have been advocated:

  • Degeneration of Auerbach's plexus causing failure of relaxation of the cardiac orifice.

  • Degeneration in utero due to ischaemia during rotation of the gut.

  • Abnormal pinch-cock action of the right crus of the diaphragm.

  • Chaga's disease (trypanosomiasis).


Carcinoma of the Oesophagus

  • Sex: It occurs more commonly in males.

  • Age: Usually it occurs between the age of 50 to 70 years.

  • Predisposing factors are longstanding lesions like oesophagitis, stricture, achalasia, Plummer Vinson syndrome and diverticulum.

  • Smoking and alcohol also predispose to malignancy.

Symptoms

Dysphagia

  • Dysphagia occurs initially for solids and later for liquids also. Patient often complains of a lump in the throat.

  • Pallor due to iron deficiency anaemia is present.

  • Angular stomatitis, glossitis, koilonychia (spoon-shaped) nails and splenomegaly may be present.

  • Web formation occurs in cricopharyngeal region.

  • Precancerous: As this is a precancerous lesion, few cases may progress to postcricoid carcinoma.


Gastro-Oesophageal Reflux

  • Throat: Vague discomforts like irritation, coughing and burning may occur in the throat.

  • Chest: Substernal pain, heart burn and rarely regurgitation may occur.


Achalasia Cardia (Cardiospasm)

  • Young age groups of either sex is affected.

  • Dysphagia is progressive, more to liquids than solids, and there is epigastric discomfort.

  • Regurgitation of undigested food may occur. Later, pulmonary complications due to aspiration may occur.

  • Loss of weight may occur, which is not very severe.


Carcinoma of the Oesophagus

  • Discomfort or feeling of a lump is the earliest symptom

  • Dysphagia is progressive. Initially it is for solids but later it is for liquids also.

  • Weight loss or cachexia may occur.

  • Cough: In higher lesions, cough or aspiration may be present.

  • Hoarsness may occur if recurrent laryngeal nerve is involved.

  • Swelling: Supraclavicular nodal enlargement may appear.


Other Oesophageal Symptoms

  • Pain is caused by inflammatory lesions, corrosive poisonings, perforation and malignancy. It is usually retrosternal or may radiate to the back between the shoulder blades.

  • Regurgitation of Food may occur with cardiospasm, pharyngeal diverticulum and advanced cases of malignancy.

  • Haematemesis and malaena may be present in traumatic, infective and malignant lesions. Varicose veins may also cause haematemesis.

  • Pulmonary Symptoms

(i) Cough may be due to food regurgitating into the tracheobronchial tree.

(ii) Dyspnoea and hoarseness due to the paralysis of the recurrent laryngeal nerves, may occur in oesophageal malignancy.

  • Spread of malignancy with metastatic lymph nodes may occur with malignant lesions of the oesophagus. 

  • Cachexia may occur with chronic dysphagia.

  • Early cases: No symptoms or signs may be present.

  • Acute dysphagia may be due to foreign bodies or acute oesophagitis.

  • Chronic dysphagia may be converted to acute dysphagia when a small foreign body or improperly masticated food gets stuck on chronic obstruction.

  • With stricture and malignancy, usually there is difficulty in swallowing solids, but with achalasia cardia, swallowing of liquids is difficult.

  • Other oesophageal symptoms also help in diagnosing the cause of dysphagia.


Treatments

  • Dysphagia cause has to be ruled and then can be treated. Dysphagia caused by many causes like stricture, hiatus hernia, spasm, tetanus, myasthenia gravis and many more can be very accurately cured by Homoeopathy. Homoeopathy works deeply on these  causes and cures it deeply so that the symptoms are also removed without any further complications or recurrence. Homeopathic medications which help in such patients are lachesis,hyoscyamus, zincum metallicum etc. 

  • For oesophageal symptoms like pain, regurgitation of food, haematemesis, pulmonary symptoms like cough, dyspnoea and hoarseness, malignancy, cachexia etc Homoeopathy has huge scope. Such symptoms can easily be cured by Homoeopathy. Homeopathic Medications which help in such symptoms are phosphorus, sticta, chamomilla etc

  • Dysphasia lusoria which occurs in chest can be cured by Homoeopathy by curing its cause by deep acting constitutional medicines. 

  • Strictures of oesophagus has good scope in homeopathy. Homeopathy acts well on muscular organs of the body and can help in correcting such structural changes also. Homeopathic remedies which help in such conditions are Kali carb, arsenic album, baryta carbonica etc. 

  • ⁠Plummer Vinson syndrome leads to dysphagia, iron deficiency anemia, oesophageal webs. Homoeopathy heals the patients from within by acting on its affected organs and the lowered immunity of the patient. Thereby the disease is cured and the symptoms are resolved. Homeopathic medications which help in such conditions are ferrum phosphoricum, zincum metallicum, aletris ferinosa etc. 

  • ⁠Oesophageal hypermotility again can be treated by homeopathic system of medicine. The cause of symptom is corrected and thereby the symptoms are also corrected. Homeopathic Medications which help in such conditions are robinia, carbo veg, Kali carb etc.  

  • ⁠GERD is totally curable by homeopathy. It’s a gastric condition which has its effects on oesophagus as well. Homeopathic medications which help in such patients are arsenic album, calcarea carbonica, lycopodium etc. 

  • Achalasia cardia cures the oesophageal muscle and its sphincter and restores this pathology. Homeopathic remedies which treats such disorders are kali carb, phosphorus, carbo veg etc. 

  • Carcinoma of oesophagus can also be treated by this system of medicine I.e Homoeopathy. Carcinoma itself can be cured by homeopathy as this medications act deeply on human organs. Homoeopathic Medications which treats such patients are condurango, nitric acid, carbo animalis etc

Esophageal disorders
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