Esophageal obstruction can be complete or partial and is caused by benign or malignant tumors or foreign bodies located within the lumen, wall (intramural) or outside the wall (extrinsic obstruction) of the esophagus. Intraluminal causes besides the above-mentioned etiologies include strictures secondary to corrosive ingestion, esophagitis (secondary to gastroesophageal reflux or infections) and esophageal webs which can be congenital or acquired. Intramural tumors can cause obstruction by narrowing the esophagus. Similarly, extrinsic factors like thyromegaly, cervical swellings, anomalous blood vessels (dysphagia lusoria), aneurysms of the aorta, left atrial enlargement, vertebral osteophytes, and malignant pulmonary tumors can compress the esophagus leading to obstruction of its lumen.

Patients present with progressively increasing dysphagia to either solids or liquids depending upon the etiology of the obstruction. In malignant lesions, the dysphagia to solids is the initial symptom, progressing to semi-solids and finally to liquids [1]. Anorexia, loss of appetite, weight loss, asthenia and nutritional deficiencies develop over a period of time. Drooling may be noticed if there is a complete luminal obstruction. This leads eventually to cachexia and influences the patient's quality and duration of life [2] [3]. The nutritional status in these patients determines the prognosis [4]. Patients with partial esophageal obstruction may have a sensation of food or foreign body getting stuck in the throat.

• Dysphagia

  The median dysphagia score dropped from 3 (able to eat liquids only) to 1 (some dysphagia with solid food), and seven of the eight patients had an improvement of at least two grades of dysphagia. Mean survival was 87 days (range 17-226). [ncbi.nlm.nih.gov]

• Odynophagia

  Elderly patients are at especially at risk because they often have few teeth. [1] Odynophagia Partial obstruction of the esophagus can cause odynophagia. [1] Sialorrhea Sialorrhea refers to excessive accumulation of saliva, because patients cannot swallow [explainmedicine.com]

  A blockage of the esophagus may cause a number of symptoms including discomfort or pain when eating and swallowing ( odynophagia ), difficulty swallowing ( dysphagia ) and regurgitation. [healthhype.com]

  Case Report A 43-year old man presented to the emergency room with a one-day history of odynophagia and dysphagia. He had taken 3 tablets of nelfinavir obtained from his partner's medication cabinet in a suicidal attempt. [ispub.com]

  There may be pain or discomfort during eating and swallowing, a condition referred to as odynophagia. Difficulty in swallowing (technically known as dysphagia) may occur. In some cases, regurgitation of food may also occur. [phaa.com]

  […] in throat Gagging Irritability Pain in neck, throat, or chest Recurrent aspiration pneumonia Respiratory distress Stridor Tachypnea or dyspnea Vomiting Wheezing TABLE 1 Symptoms of Esophageal Foreign Bodies Blood in saliva Coughing Drooling Dysphagia/odynophagia [aafp.org]

• Aphagia

  A case report is presented of an 86-year-old man in a very poor general condition with a 10-year history of a Zenker's diverticulum as a cause of a complete obstruction of the esophagus with subsequent aphagia and massive cachexia. [ncbi.nlm.nih.gov]

• Gagging

  […] esophagorespiratory fistulae, diverticula, epithelial inclusion cysts. esophageal atresia congenital lack of continuity of the esophagus, commonly accompanied by tracheoesophageal fistula, and characterized by accumulations of mucus in the nasopharynx, gagging [medical-dictionary.thefreedictionary.com]

  […] moves up through a small opening into the chest— hiatal hernia Chronic inflammation in the esophagus—eosinophilic esophagitis Esophageal cancer or other tumors Symptoms Steakhouse syndrome may cause: Chest pain Difficulty swallowing Drooling Coughing, gagging [winchesterhospital.org]

  […] esophageal sphincter, pylorus, and ileocecal valve. 1, 2, 4 View/Print Table TABLE 1 Symptoms of Esophageal Foreign Bodies Blood in saliva Coughing Drooling Dysphagia/odynophagia Failure to thrive Fever Food refusal Foreign body sensation in throat Gagging [aafp.org]

• Chest Pain

  Early (within 48 hours) procedure-related complications occurred in 4 of 13 patients and consisted of minor, transient chest pain that resolved within 6 hours (3 patients) and endoscopic stent dislodgment into the stomach (1 patient). [ncbi.nlm.nih.gov]

  Patients experience diffuse retrosternal chest pain due to esophageal spasm and obstruction. [explainmedicine.com]

  This causes chest pain and inability to swallow saliva. Attempts to relieve the obstruction by inducing vomiting at home are usually unsuccessful. Patients with complete esophageal obstruction can breathe and are not at risk of suffocation. [medicinenet.com]

• Heart Disease

  Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Diabetes care. 1999 Jun;22(6):913-9. PubMed PMID: 10372241. 22. [inutro.com]

  A right aortic arch with mirror-image branching however is almost always associated with congenital heart disease. [radiologyassistant.nl]

• Retrosternal Chest Pain

  Patients experience diffuse retrosternal chest pain due to esophageal spasm and obstruction. [explainmedicine.com]

• Ulcer

  She subsequently presented with complete obstruction of the esophageal lumen with ulceration, which was seen on repeat EGD. Following conservative management, EGD demonstrated scarring around the ulcerated region and a patent esophagus. [ncbi.nlm.nih.gov]

  One of the most common causes is erosivno-yazate reflux esophagitis and peptic rubcujushhiesja ulcer of oesophagus. [omedicine.info]

  […] functioning esophagus. esophageal enlargement clinically visible enlargement as seen in esophageal diverticulum, stenosis, paralysis, cardial obstruction. esophageal fibrosis a cause of acquired megaesophagus; usually caused by trauma or spontaneous ulceration [medical-dictionary.thefreedictionary.com]

  Esophageal carcinoma with ulcerations (arrows) and sharp right angle junction with esophageal wall (arrowheads) This image is of a patient with an infiltrative ulcerated carcinoma. [radiologyassistant.nl]

The workup in a case of this disease includes history taking, complete physical and neurological examination, followed by laboratory tests, endoscopic evaluation, and imaging studies. Anamnestic data will provide information on the foreign body or caustic ingestion and details about the onset, duration, progress and degree of dysphagia. Physical examination will help detect nutritional abnormalities, thyromegaly, and cardiac or pulmonary etiology of the swallowing dysfunction. A thorough neurological examination is required to exclude neuromuscular causes of dysphagia.

Laboratory tests such as vitamin B12 levels, thyroid stimulating hormone levels (TSH) and creatine kinase should be ordered as part of the workup.

A plain X-ray chest may reveal a lung tumor or an enlarged left atrium compressing the esophagus. Non-invasive imaging studies like videofluoroscopy [5] and barium swallow help to diagnose mucosal and obstructive lesions while computed tomography and magnetic resonance imaging are required to delineate the extent of the obstructive growths and can also detect anomalous blood vessels.

Esophagoscopy is the gold standard test to detect the cause of the esophageal obstruction [6], to remove a foreign body, dilate a stricture or obtain tissue for histological evaluation.

If gastroesophageal reflux is suspected, then 24 hour pH monitoring will be required to diagnose the cause. Electromyography [7] and manometry can also be performed if indicated by history and physical examination findings.

• Esophageal Motility Disorder

  [1,2] History of esophageal motility disorders Achalasia and other esophageal motility disorders can precipitate esophageal obstruction. [2] [explainmedicine.com]

  foreign body lodgment; cause of obstructive bloat. esophageal hyperkeratosis hyperkeratotic thickening of the esophageal mucosa due usually to hypovitaminosis A or chlorinated naphthalene poisoning. esophageal motility disorders esophageal neoplasm [medical-dictionary.thefreedictionary.com]

  Risk Factors Factors that may increase your chances of steakhouse syndrome: Not chewing your food completely Drinking too much alcohol Wearing dentures Having a physical problem that affects how food moves down the esophagus: Esophageal motility disorder [winchesterhospital.org]

  Semin Thorac Cariovasc Surg 1999;11:326-36 70077-8/abstract)/ “Achalasia and esophageal motility disorders,” STS Patient Information, accessed 9-20-06. Rice TW, Baker ME. Midthoracic esophageal diverticula. [my.clevelandclinic.org]

  Journal of neurogastroenterology and motility. Jul 2013;19(3):281-294. 3.Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. [gi.dxy.cn]

• Polyps

  Benign growths mainly comprise of leiomyomas and polyps while cancerous lesions include adenocarcinomas and squamous cell carcinomas. [healthhype.com]

  Pedunculated fibrovascular polyps Fibrovascular polyp Pedunculated fibrovascular polyps are rare lesions, that are difficult to diagnose on esophagrams. Their movement during the examination produces an inconstant position. [radiologyassistant.nl]

  Examples include polyps, leiomyomas, squamous cell carcinomas and adenocarcinomas. In addition to tumors, pouch-shaped outgrowths from the intestinal wall can also result in blockage of the esophageal lumen. [phaa.com]

  Snares, which are normally used to remove polyps can be used to macerate the food causing the obstruction. [en.wikipedia.org]

  Using a combination of radiographic control and transillumination from above with another endoscope, we were able to make a guidewire puncture through a short stricture, place the guidewire into the hypopharynx, and seize the guidewire with a polyp snare [gastroenterologyandhepatology.net]

The rates of reintervention were similar in both treatment groups, as were the 30-day mortality rates. [ncbi.nlm.nih.gov]

The nutritional status in these patients determines the prognosis. Patients with partial esophageal obstruction may have a sensation of food or foreign body getting stuck in the throat. [symptoma.com]

A more detailed subclassification of early esophageal cancer has been proposed for determining prognosis and selecting treatment. [clinicaladvisor.com]

Patients present with progressively increasing dysphagia to either solids or liquids depending upon the etiology of the obstruction. [symptoma.com]

Etiology  Large food bolus with no underlying cause  Strictures or stenosis  Carcinoma  Shatzki’s ring (15% of people have fibrous stricture near GE junction) [scribd.com]

However, the etiology remains unknown in many cases. [acgcasereports.gi.org]

Clinical Take Home Point: Given the weak evidence for the benefits of glucagon, the potential side effect of nausea/vomiting, and the fact that nearly 1/4 th of patients will have an anatomic etiology to their obstruction, avoid the use of glucagon and [rebelem.com]

Acute esophageal syndromes In the table on the left are etiologies of an acute esophageal syndrome. Boerhaave syndrome Boerhaave syndrome is rupture of the esophageal wall. [radiologyassistant.nl]

Esophageal food impaction: epidemiology and therapy. A retrospective study, observational study. Gastrointestinal Endoscopy. 2001;53:193-198. Gretarsdottir HM, Jonasson JG, Bjornsson ES. [appliedradiology.com]

"Esophageal food impaction: epidemiology and therapy. A retrospective, observational study". Gastrointestinal Endoscopy. 53 (2): 193–8. doi : 10.1067/mge.2001.112709. PMID 11174291. ^ a b c d Kerlin P, Jones D, Remedios M, Campbell C (2007). [en.wikipedia.org]

Conclusion Our understanding of the pathophysiology and treatment of achalasia has increased significantly. [hon.ch]

“Pathophysiology and treatment of Barrett's esophagus”. World J Gastroenterol. vol. 16. 2010. pp. 3762-72. Lagarde, SM, ten Kate, FJ, Richel, DJ. “Molecular prognostic factors in adenocarcinoma of the esophagus and gastroesophageal junction”. [clinicaladvisor.com]

In 1 patient with an esophagorespiratory fistula, the prosthesis successfully occluded the fistula and prevented aspiration or pulmonary infection until the patient's death. [ncbi.nlm.nih.gov]

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3. Fearon K, Strasser F, Anker SD, Bosaeus I, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2010;12:489–95.
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