1. Achalasia
   1. Pathophysiology
      1. Asperistalsis 遠端食道無蠕動, 中下無蠕動
      2. 下括約肌弛緩異常, >45mmHg
      3. 食道下1/3不能放鬆
   2. Male = Female
   3. S/S
      1. GERD
      2. Dysphagia
         1. 液體與固體
      3. Chest pain
   4. Secondary
      1. Paraneoplastic syndrome
         1. Esophageal or gastric cancer
   5. Tx:
      1. Heller's myotomy operation
         1. AND/OR Anti-reflex procedure
      2. Drug
         1. Nitrate
         2. CCB
         3. injection of Botulism
      3. 食道擴張術
         1. 60-80% 成功率
         2. 30% Recurrence
         3. 3-5% esophageal rupture
   6. Dx
      1. Esophagogram
      2. Esophageal manometry
      3. UGI barium study
         1. Birdbeak-like
         2. 少見食道裂孔
   7. Complication
      1. Aspiration pneumonia
      2. Esophageal cancer, SCC
2. Polymyositis
   1. 1/3U sketetal muscle involvement
3. Scelroderma
   1. 2/3L smooth mo\uscle atropht, low tone.
   2. LES dysfunction
   3. Solid food dysphagia
   4. Esophegus: Thin and fibrotic spot
4. GERD
   1. LES dysfunction
   2. Most common cause of non-cardiogenic chest pain
   3. Etiology
      1. Scleroderma
   4. Dx:
      1. 24hr PH monitor
      2. Bernstein Test
      3. PES
      4. Biopsy
      5. Therpay reponse
   5. Complication
      1. Barret's esophagus
      2. Adenocarcinoma
      3. IDA
      4. Aspiration pneumonia
      5. Esophagitis
   6. Tx:
      1. Life style
      2. Rx: PPI, primparan or H2 block
      3. OP
5. Diffuse esophageal spasm
   1. Non-peristaltic contraction
   2. Corkscrew esophagus
6. Esophagitis
   1. Corrosive
      1. Acid:coagulation necrosis
         1. Pyrotic stenosis
      2. Alkali: penetration, liquilization
      3. Tx
         1. NPO, IVF
         2. 不可催吐
         3. PES <48hours
   2. Viral
      1. Scopy
         1. Vesicles, fibrinous exudate
         2. ballooning degeneration
         3. , eosinophilic intranuclear inclusion
      2. HSV. VZV, CMV, HIV
   3. Candiasis
      1. Immuncompromised
      2. Multiple yellow plague
7. Zenker's pouch
   1. Pu;sopm type Diverticulum
   2. Congenital weak point over post-wall of hypopharyngeal
   3. Above cricopharyngeal muscle
   4. Esophgeal Barium study
8. Esophageal ring/Webs
   1. Scgatzki's ring
   2. Lower esophageal mucosal ring
   3. Below LES
   4. Solid dysphagia
9. Esophageal cancer
   1. Cell type
      1. SCC
         1. Most common in 2/3U
         2. Achalasia related
      2. Adenocarcinoma
         1. 1/3L
         2. GERD, Barret's related